Provider Demographics
NPI:1861847360
Name:STANLEY, JANAYA LATRICE (LCSW-C)
Entity Type:Individual
Prefix:
First Name:JANAYA
Middle Name:LATRICE
Last Name:STANLEY
Suffix:
Gender:F
Credentials:LCSW-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1118 LINKSIDE DR
Mailing Address - Street 2:
Mailing Address - City:PARKVILLE
Mailing Address - State:MD
Mailing Address - Zip Code:21234-5914
Mailing Address - Country:US
Mailing Address - Phone:410-294-7944
Mailing Address - Fax:410-294-7944
Practice Address - Street 1:1118 LINKSIDE DR
Practice Address - Street 2:
Practice Address - City:PARKVILLE
Practice Address - State:MD
Practice Address - Zip Code:21234-5914
Practice Address - Country:US
Practice Address - Phone:410-294-7944
Practice Address - Fax:410-294-7944
Is Sole Proprietor?:Yes
Enumeration Date:2016-05-03
Last Update Date:2022-08-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD17874104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD114697100Medicaid