Provider Demographics
NPI:1972787802
Name:SPONAUGLE, PAULA R (LCSW-C)
Entity Type:Individual
Prefix:
First Name:PAULA
Middle Name:R
Last Name:SPONAUGLE
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 1:3416 OLANDWOOD CT STE 201
Mailing Address - Street 2:
Mailing Address - City:OLNEY
Mailing Address - State:MD
Mailing Address - Zip Code:20832-1373
Mailing Address - Country:US
Mailing Address - Phone:240-277-1637
Mailing Address - Fax:
Practice Address - Street 1:3416 OLANDWOOD CT STE 201
Practice Address - Street 2:
Practice Address - City:OLNEY
Practice Address - State:MD
Practice Address - Zip Code:20832-1373
Practice Address - Country:US
Practice Address - Phone:240-277-1637
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-12-27
Last Update Date:2007-12-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD058621041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical