Provider Demographics
NPI:1104608819
Name:SAYLES, ETHEL DORIS
Entity type:Individual
Prefix:
First Name:ETHEL
Middle Name:DORIS
Last Name:SAYLES
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6500 SEVEN LOCKS RD STE 206
Mailing Address - Street 2:
Mailing Address - City:CABIN JOHN
Mailing Address - State:MD
Mailing Address - Zip Code:20818-1300
Mailing Address - Country:US
Mailing Address - Phone:301-514-6920
Mailing Address - Fax:
Practice Address - Street 1:6500 SEVEN LOCKS RD STE 206
Practice Address - Street 2:
Practice Address - City:CABIN JOHN
Practice Address - State:MD
Practice Address - Zip Code:20818-1300
Practice Address - Country:US
Practice Address - Phone:301-514-6920
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-10-17
Last Update Date:2023-10-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA09030035341041C0700X
DCLG2000017071041C0700X
MD242011041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical