Provider Demographics
NPI:1598492555
Name:WOJTILA, DANTE TERRELL (LCSW-C)
Entity Type:Individual
Prefix:
First Name:DANTE
Middle Name:TERRELL
Last Name:WOJTILA
Suffix:
Gender:M
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 1:7906 HADLEY CT
Mailing Address - Street 2:
Mailing Address - City:SEVERN
Mailing Address - State:MD
Mailing Address - Zip Code:21144-2078
Mailing Address - Country:US
Mailing Address - Phone:443-977-0107
Mailing Address - Fax:
Practice Address - Street 1:7906 HADLEY CT
Practice Address - Street 2:
Practice Address - City:SEVERN
Practice Address - State:MD
Practice Address - Zip Code:21144-2078
Practice Address - Country:US
Practice Address - Phone:443-977-0107
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-08-01
Last Update Date:2022-08-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD252801041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Single Specialty