Provider Demographics
NPI:1437850443
Name:BELTON, MYIA (LGSW)
Entity Type:Individual
Prefix:
First Name:MYIA
Middle Name:
Last Name:BELTON
Suffix:
Gender:F
Credentials:LGSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:12401 JAMES MADISON LN
Mailing Address - Street 2:
Mailing Address - City:GLENN DALE
Mailing Address - State:MD
Mailing Address - Zip Code:20769-9168
Mailing Address - Country:US
Mailing Address - Phone:301-379-6436
Mailing Address - Fax:
Practice Address - Street 1:12401 JAMES MADISON LN
Practice Address - Street 2:
Practice Address - City:GLENN DALE
Practice Address - State:MD
Practice Address - Zip Code:20769-9168
Practice Address - Country:US
Practice Address - Phone:240-853-1243
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-03-15
Last Update Date:2023-11-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DCCACII200001200101YA0400X
DCLG200001299104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)