Provider Demographics
NPI:1750815999
Name:ENSLEY-CREWS, VAKEEMA (LGPC,LGADC)
Entity Type:Individual
Prefix:
First Name:VAKEEMA
Middle Name:
Last Name:ENSLEY-CREWS
Suffix:
Gender:F
Credentials:LGPC,LGADC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:14402 BEL PRE DR
Mailing Address - Street 2:
Mailing Address - City:SILVER SPRING
Mailing Address - State:MD
Mailing Address - Zip Code:20906-2250
Mailing Address - Country:US
Mailing Address - Phone:240-630-4334
Mailing Address - Fax:
Practice Address - Street 1:14402 BEL PRE DR
Practice Address - Street 2:
Practice Address - City:SILVER SPRING
Practice Address - State:MD
Practice Address - Zip Code:20906-2250
Practice Address - Country:US
Practice Address - Phone:240-630-4334
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-04-14
Last Update Date:2017-04-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDLGP7206101Y00000X
MDLGA2186101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)