Provider Demographics
NPI:1689386351
Name:EGLETON, MYIA C (LMSW)
Entity Type:Individual
Prefix:DR
First Name:MYIA
Middle Name:C
Last Name:EGLETON
Suffix:
Gender:F
Credentials:LMSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:14403 COLONELS CHOICE
Mailing Address - Street 2:
Mailing Address - City:UPPER MARLBORO
Mailing Address - State:MD
Mailing Address - Zip Code:20772-2878
Mailing Address - Country:US
Mailing Address - Phone:803-509-4982
Mailing Address - Fax:
Practice Address - Street 1:14403 COLONELS CHOICE
Practice Address - Street 2:
Practice Address - City:UPPER MARLBORO
Practice Address - State:MD
Practice Address - Zip Code:20772-2878
Practice Address - Country:US
Practice Address - Phone:803-509-4982
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-12-14
Last Update Date:2022-12-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD26718104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker