Provider Demographics
NPI:1477959799
Name:FUNKHOUSER, LAURA TERESA BEGOSH (LCSW-C)
Entity type:Individual
Prefix:
First Name:LAURA
Middle Name:TERESA BEGOSH
Last Name:FUNKHOUSER
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 1:16220 FREDERICK RD
Mailing Address - Street 2:SUITE 502
Mailing Address - City:GAITHERSBURG
Mailing Address - State:MD
Mailing Address - Zip Code:20877-4039
Mailing Address - Country:US
Mailing Address - Phone:202-827-5830
Mailing Address - Fax:
Practice Address - Street 1:16220 FREDERICK RD
Practice Address - Street 2:SUITE 502
Practice Address - City:GAITHERSBURG
Practice Address - State:MD
Practice Address - Zip Code:20877-4039
Practice Address - Country:US
Practice Address - Phone:240-423-8040
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-11-13
Last Update Date:2022-04-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD142081041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical