Provider Demographics
NPI:1356359103
Name:VOGELPOHL-BAXTER, THERESA LYNN (LCSW-C)
Entity type:Individual
Prefix:MRS
First Name:THERESA
Middle Name:LYNN
Last Name:VOGELPOHL-BAXTER
Suffix:
Gender:F
Credentials:LCSW-C
Other - Prefix:MRS
Other - First Name:THERESA
Other - Middle Name:LYNN
Other - Last Name:BAXTER
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:LCSW-C
Mailing Address - Street 1:2310 PUTNAM LN
Mailing Address - Street 2:
Mailing Address - City:CROFTON
Mailing Address - State:MD
Mailing Address - Zip Code:21114-1646
Mailing Address - Country:US
Mailing Address - Phone:443-267-8029
Mailing Address - Fax:
Practice Address - Street 1:2485 DAVIDSONVILLE RD
Practice Address - Street 2:
Practice Address - City:GAMBRILLS
Practice Address - State:MD
Practice Address - Zip Code:21054-2111
Practice Address - Country:US
Practice Address - Phone:443-267-8029
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-04
Last Update Date:2017-12-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD087851041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD378310300Medicaid
MD424794Medicare UPIN