Provider Demographics
NPI:1376667477
Name:SANCHO-DAVILA-MORELAND, JUANA ROSA (LICSW-C)
Entity Type:Individual
Prefix:MRS
First Name:JUANA
Middle Name:ROSA
Last Name:SANCHO-DAVILA-MORELAND
Suffix:
Gender:F
Credentials:LICSW-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8774 ENDLESS OCEAN WAY
Mailing Address - Street 2:
Mailing Address - City:COLUMBIA
Mailing Address - State:MD
Mailing Address - Zip Code:21045
Mailing Address - Country:US
Mailing Address - Phone:410-292-5149
Mailing Address - Fax:
Practice Address - Street 1:8774 ENDLESS OCEAN WAY
Practice Address - Street 2:
Practice Address - City:COLUMBIA
Practice Address - State:MD
Practice Address - Zip Code:21045
Practice Address - Country:US
Practice Address - Phone:410-292-5149
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-16
Last Update Date:2021-10-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DCLC302291101YM0800X
MD07926101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health