Provider Demographics
NPI:1700208394
Name:NORTHINGTON, KECIA (LGSW)
Entity Type:Individual
Prefix:MRS
First Name:KECIA
Middle Name:
Last Name:NORTHINGTON
Suffix:
Gender:F
Credentials:LGSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1282 SMALLWOOD DR W
Mailing Address - Street 2:SUITE #306
Mailing Address - City:WALDORF
Mailing Address - State:MD
Mailing Address - Zip Code:20603-4732
Mailing Address - Country:US
Mailing Address - Phone:240-416-9626
Mailing Address - Fax:
Practice Address - Street 1:1282 SMALLWOOD DR W
Practice Address - Street 2:SUITE #306
Practice Address - City:WALDORF
Practice Address - State:MD
Practice Address - Zip Code:20603-4732
Practice Address - Country:US
Practice Address - Phone:240-416-9626
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-01-15
Last Update Date:2014-05-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD16385104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker