Provider Demographics
NPI:1699014738
Name:BRICKHOUSE, KATRINA RENISE (LICSW)
Entity Type:Individual
Prefix:MRS
First Name:KATRINA
Middle Name:RENISE
Last Name:BRICKHOUSE
Suffix:
Gender:F
Credentials:LICSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1004 ASHLEIGH STATION CT
Mailing Address - Street 2:
Mailing Address - City:BOWIE
Mailing Address - State:MD
Mailing Address - Zip Code:20721-6007
Mailing Address - Country:US
Mailing Address - Phone:202-679-1615
Mailing Address - Fax:
Practice Address - Street 1:1004 ASHLEIGH STATION CT
Practice Address - Street 2:
Practice Address - City:BOWIE
Practice Address - State:MD
Practice Address - Zip Code:20721-6007
Practice Address - Country:US
Practice Address - Phone:202-679-1615
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-02-09
Last Update Date:2013-02-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DCLC500795011041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical