Provider Demographics
NPI:1639546096
Name:DURHAM, LORI (LCSW-C)
Entity Type:Individual
Prefix:
First Name:LORI
Middle Name:
Last Name:DURHAM
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 1:5024 OGLETHORPE ST
Mailing Address - Street 2:
Mailing Address - City:RIVERDALE
Mailing Address - State:MD
Mailing Address - Zip Code:20737-2039
Mailing Address - Country:US
Mailing Address - Phone:301-741-0985
Mailing Address - Fax:
Practice Address - Street 1:1330 MCCORMICK DR
Practice Address - Street 2:
Practice Address - City:LARGO
Practice Address - State:MD
Practice Address - Zip Code:20774-5398
Practice Address - Country:US
Practice Address - Phone:301-772-1200
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-09-01
Last Update Date:2015-09-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD166121041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical