Provider Demographics
NPI:1245513621
Name:HOWARD, AUDRA A (LCSW-C)
Entity type:Individual
Prefix:MRS
First Name:AUDRA
Middle Name:A
Last Name:HOWARD
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:PO BOX 1554
Mailing Address - Street 2:
Mailing Address - City:SOLOMONS
Mailing Address - State:MD
Mailing Address - Zip Code:20688-1554
Mailing Address - Country:US
Mailing Address - Phone:443-771-7265
Mailing Address - Fax:508-433-1871
Practice Address - Street 1:90 HOLIDAY DRIVE
Practice Address - Street 2:UNIT A
Practice Address - City:SOLOMONS
Practice Address - State:MD
Practice Address - Zip Code:20688-9998
Practice Address - Country:US
Practice Address - Phone:443-771-7265
Practice Address - Fax:508-433-1871
Is Sole Proprietor?:Yes
Enumeration Date:2011-09-22
Last Update Date:2023-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD189901041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD589561803Medicaid