Provider Demographics
NPI:1265749527
Name:TETTEH, COMFORT (LCSW-C)
Entity type:Individual
Prefix:
First Name:COMFORT
Middle Name:
Last Name:TETTEH
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 1:22940 NEWCUT RD
Mailing Address - Street 2:
Mailing Address - City:CLARKSBURG
Mailing Address - State:MD
Mailing Address - Zip Code:20871-9307
Mailing Address - Country:US
Mailing Address - Phone:240-561-2274
Mailing Address - Fax:301-710-6540
Practice Address - Street 1:501 N FREDERICK AVE
Practice Address - Street 2:STE 300
Practice Address - City:GAITHERSBURG
Practice Address - State:MD
Practice Address - Zip Code:20877-2507
Practice Address - Country:US
Practice Address - Phone:240-561-2274
Practice Address - Fax:301-710-6540
Is Sole Proprietor?:Yes
Enumeration Date:2010-09-08
Last Update Date:2016-09-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD167861041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD0661104Medicaid