Provider Demographics
NPI:1669857538
Name:DAUSCH, CONNIE (LCPC)
Entity Type:Individual
Prefix:
First Name:CONNIE
Middle Name:
Last Name:DAUSCH
Suffix:
Gender:F
Credentials:LCPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1203 CARSINWOOD CT
Mailing Address - Street 2:
Mailing Address - City:ABERDEEN
Mailing Address - State:MD
Mailing Address - Zip Code:21001
Mailing Address - Country:US
Mailing Address - Phone:443-662-7008
Mailing Address - Fax:
Practice Address - Street 1:100 ST JOHN STREET
Practice Address - Street 2:SUITE 1
Practice Address - City:HAVRE DE GRACE
Practice Address - State:MD
Practice Address - Zip Code:21078
Practice Address - Country:US
Practice Address - Phone:443-662-7008
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-07-21
Last Update Date:2018-04-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDLC5967101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional