Provider Demographics
NPI:1841834009
Name:CHILDRESS, MARIA L (MSW, LCSW)
Entity type:Individual
Prefix:
First Name:MARIA
Middle Name:L
Last Name:CHILDRESS
Suffix:
Gender:F
Credentials:MSW, LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1329 MACKLIND AVE STE 200
Mailing Address - Street 2:
Mailing Address - City:SAINT LOUIS
Mailing Address - State:MO
Mailing Address - Zip Code:63110-1400
Mailing Address - Country:US
Mailing Address - Phone:314-645-7800
Mailing Address - Fax:314-645-7802
Practice Address - Street 1:1329 MACKLIND AVE STE 200
Practice Address - Street 2:
Practice Address - City:SAINT LOUIS
Practice Address - State:MO
Practice Address - Zip Code:63110-1400
Practice Address - Country:US
Practice Address - Phone:314-645-7800
Practice Address - Fax:314-645-7802
Is Sole Proprietor?:No
Enumeration Date:2019-10-31
Last Update Date:2019-10-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO20040224251041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical