Provider Demographics
NPI:1295780658
Name:GOUGH, LARHONDA S (LICSW)
Entity type:Individual
Prefix:
First Name:LARHONDA
Middle Name:S
Last Name:GOUGH
Suffix:
Gender:F
Credentials:LICSW
Other - Prefix:
Other - First Name:LARHONDA
Other - Middle Name:S
Other - Last Name:MINGO
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LICSW
Mailing Address - Street 1:2204 E MARLBORO AVE
Mailing Address - Street 2:
Mailing Address - City:HYATTSVILLE
Mailing Address - State:MD
Mailing Address - Zip Code:20785-5205
Mailing Address - Country:US
Mailing Address - Phone:240-432-4030
Mailing Address - Fax:
Practice Address - Street 1:2204 E MARLBORO AVE
Practice Address - Street 2:
Practice Address - City:HYATTSVILLE
Practice Address - State:MD
Practice Address - Zip Code:20785-5205
Practice Address - Country:US
Practice Address - Phone:240-432-4030
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-05-24
Last Update Date:2021-06-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DCLC500782911041C0700X
MD131081041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical