Provider Demographics
NPI:1629542998
Name:BOOKER, TEYAWANDA (LCSW-C)
Entity Type:Individual
Prefix:MRS
First Name:TEYAWANDA
Middle Name:
Last Name:BOOKER
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 1:7724 MELLOW CT
Mailing Address - Street 2:
Mailing Address - City:HANOVER
Mailing Address - State:MD
Mailing Address - Zip Code:21076-1583
Mailing Address - Country:US
Mailing Address - Phone:240-440-7267
Mailing Address - Fax:
Practice Address - Street 1:1895 BRIGHTSEAT RD
Practice Address - Street 2:
Practice Address - City:HYATTSVILLE
Practice Address - State:MD
Practice Address - Zip Code:20785-4250
Practice Address - Country:US
Practice Address - Phone:301-773-8201
Practice Address - Fax:307-773-8203
Is Sole Proprietor?:Yes
Enumeration Date:2019-01-19
Last Update Date:2019-01-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD193691041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD19369OtherBOARD OF SOCIAL WORK EXMAINER