Provider Demographics
NPI:1629891593
Name:GARDNER, DARLENE ALEXIA (LCSW-C)
Entity type:Individual
Prefix:
First Name:DARLENE
Middle Name:ALEXIA
Last Name:GARDNER
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 1:11445 CHERRY HILL RD APT 202
Mailing Address - Street 2:
Mailing Address - City:BELTSVILLE
Mailing Address - State:MD
Mailing Address - Zip Code:20705-3644
Mailing Address - Country:US
Mailing Address - Phone:301-357-1523
Mailing Address - Fax:
Practice Address - Street 1:11445 CHERRY HILL RD APT 202
Practice Address - Street 2:
Practice Address - City:BELTSVILLE
Practice Address - State:MD
Practice Address - Zip Code:20705-3644
Practice Address - Country:US
Practice Address - Phone:301-357-1523
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-11-07
Last Update Date:2024-11-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD278811041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical