Individual provider · NPI-1

Davidra Bazemore-Blue, MSW, LCSW-C

Social Worker · Waldorf, MD

NPI number1124465802
StatusActive
Last updated in NPPESJan 29, 2020

Details

NPI
1124465802
Entity type
Individual (NPI-1)
Name
Davidra Bazemore-Blue
Credential
MSW, LCSW-C
Sex
Female
Sole proprietor
No
Enumeration date
Jun 4, 2013
Certification date
Jan 29, 2020
Last updated
Jan 29, 2020

Taxonomy and licenses

Taxonomy codeDescriptionLicenseStatePrimary
104100000X Social Worker––Yes

Practice location

3200 Crain Hwy
Suite 203
Waldorf, MD 20603-4841

Phone 240-435-4708

Mailing address

3261 Old Washington Rd Ste 2020
Waldorf, MD 20602-3231

Phone 202-997-6060

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