Provider Demographics
NPI:1578846697
Name:WAY, KAMILAH (LICSW, LCSW-C)
Entity Type:Individual
Prefix:
First Name:KAMILAH
Middle Name:
Last Name:WAY
Suffix:
Gender:F
Credentials:LICSW, LCSW-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3600 LEONARDTOWN RD STE 203
Mailing Address - Street 2:
Mailing Address - City:WALDORF
Mailing Address - State:MD
Mailing Address - Zip Code:20601-3647
Mailing Address - Country:US
Mailing Address - Phone:240-607-2679
Mailing Address - Fax:
Practice Address - Street 1:3600 LEONARDTOWN RD STE 203
Practice Address - Street 2:
Practice Address - City:WALDORF
Practice Address - State:MD
Practice Address - Zip Code:20601-3647
Practice Address - Country:US
Practice Address - Phone:240-607-2679
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-09-25
Last Update Date:2020-01-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD181231041C0700X
DCLC500793381041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical