Provider Demographics
NPI:1336202605
Name:KOHL, JAMES FREDRICK (MSSW LCSW C)
Entity Type:Individual
Prefix:MR
First Name:JAMES
Middle Name:FREDRICK
Last Name:KOHL
Suffix:
Gender:M
Credentials:MSSW LCSW C
Other - Prefix:
Other - First Name:
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Mailing Address - Street 1:210 GOUCHER WAY
Mailing Address - Street 2:
Mailing Address - City:CHURCHVILLE
Mailing Address - State:MD
Mailing Address - Zip Code:21028
Mailing Address - Country:US
Mailing Address - Phone:410-734-6505
Mailing Address - Fax:
Practice Address - Street 1:336 SOUTH MAIN STREET STE 1 A
Practice Address - Street 2:
Practice Address - City:BEL AIR
Practice Address - State:MD
Practice Address - Zip Code:21014
Practice Address - Country:US
Practice Address - Phone:410-893-0995
Practice Address - Fax:410-339-7169
Is Sole Proprietor?:No
Enumeration Date:2006-12-18
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD07144104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker
Provider Identifiers
StateIdentifier IDID TypeIssuer
6221437OtherUNITED BEHAVIORAL HEALTH
MD58050003OtherCARE FIRST BCBS
6221437OtherUNITED BEHAVIORAL HEALTH