Provider Demographics
NPI:1548382658
Name:CHEETHAM, AUGUST A (LCSW-C)
Entity Type:Individual
Prefix:
First Name:AUGUST
Middle Name:A
Last Name:CHEETHAM
Suffix:
Gender:F
Credentials:LCSW-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:15 E MAIN ST
Mailing Address - Street 2:SUITE 224-A
Mailing Address - City:WESTMINSTER
Mailing Address - State:MD
Mailing Address - Zip Code:21157-5000
Mailing Address - Country:US
Mailing Address - Phone:410-848-5155
Mailing Address - Fax:
Practice Address - Street 1:59 KATE WAGNER RD.
Practice Address - Street 2:
Practice Address - City:WESTMINSTER
Practice Address - State:MD
Practice Address - Zip Code:21157
Practice Address - Country:US
Practice Address - Phone:410-848-2500
Practice Address - Fax:410-876-3016
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-06
Last Update Date:2016-02-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD119191041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD615501400Medicaid