Provider Demographics
NPI:1528592896
Name:AUSTIN, DARLENA (LGSW)
Entity Type:Individual
Prefix:
First Name:DARLENA
Middle Name:
Last Name:AUSTIN
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 1:30537 POTOMAC WAY
Mailing Address - Street 2:SUITE 102
Mailing Address - City:CHARLOTTE HALL
Mailing Address - State:MD
Mailing Address - Zip Code:20622-3179
Mailing Address - Country:US
Mailing Address - Phone:301-778-4127
Mailing Address - Fax:
Practice Address - Street 1:5310 EXETER PLACE
Practice Address - Street 2:
Practice Address - City:WHITE PLAINS
Practice Address - State:MD
Practice Address - Zip Code:20695
Practice Address - Country:US
Practice Address - Phone:301-778-4127
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-04-13
Last Update Date:2017-04-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD18639104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker