Provider Demographics
NPI:1598819260
Name:ACKLIN, BECKY K (MSW, LCSW-C)
Entity Type:Individual
Prefix:MRS
First Name:BECKY
Middle Name:K
Last Name:ACKLIN
Suffix:
Gender:F
Credentials:MSW, LCSW-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:14705 MOCKINGBIRD DR
Mailing Address - Street 2:
Mailing Address - City:DARNESTOWN
Mailing Address - State:MD
Mailing Address - Zip Code:20874-3341
Mailing Address - Country:US
Mailing Address - Phone:301-963-0763
Mailing Address - Fax:240-683-1341
Practice Address - Street 1:4400 E WEST HWY STE 720
Practice Address - Street 2:
Practice Address - City:BETHESDA
Practice Address - State:MD
Practice Address - Zip Code:20814-4509
Practice Address - Country:US
Practice Address - Phone:301-257-4852
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-01-22
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDMD09248101YM0800X
DCLC00302894101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
DCGO 2227T01Medicare ID - Type UnspecifiedPROVIDER