Provider Demographics
NPI:1811971617
Name:WOOLARD, LOUIS ERVIN JR (LCSWC)
Entity type:Individual
Prefix:
First Name:LOUIS
Middle Name:ERVIN
Last Name:WOOLARD
Suffix:JR
Gender:M
Credentials:LCSWC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1662 VILLAGE GRN STE 100
Mailing Address - Street 2:
Mailing Address - City:CROFTON
Mailing Address - State:MD
Mailing Address - Zip Code:21114-2014
Mailing Address - Country:US
Mailing Address - Phone:410-757-2077
Mailing Address - Fax:410-721-2357
Practice Address - Street 1:1662 VILLAGE GRN STE 100
Practice Address - Street 2:
Practice Address - City:CROFTON
Practice Address - State:MD
Practice Address - Zip Code:21114-2014
Practice Address - Country:US
Practice Address - Phone:410-757-2077
Practice Address - Fax:410-573-1972
Is Sole Proprietor?:No
Enumeration Date:2005-12-05
Last Update Date:2024-11-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD095941041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD222LD860Medicare ID - Type Unspecified