Provider Demographics
NPI:1760109698
Name:ELMORE, JAMIAH PATRICE (LCSW)
Entity Type:Individual
Prefix:
First Name:JAMIAH
Middle Name:PATRICE
Last Name:ELMORE
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:915 CARNABY ST
Mailing Address - Street 2:
Mailing Address - City:STAFFORD
Mailing Address - State:VA
Mailing Address - Zip Code:22554-9442
Mailing Address - Country:US
Mailing Address - Phone:571-276-4578
Mailing Address - Fax:
Practice Address - Street 1:4401 TELFAIR BLVD
Practice Address - Street 2:
Practice Address - City:CAMP SPRINGS
Practice Address - State:MD
Practice Address - Zip Code:20746-5276
Practice Address - Country:US
Practice Address - Phone:571-276-4578
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-10-21
Last Update Date:2022-11-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY2574011041C0700X
VA09040145861041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical