Provider Demographics
NPI:1215256532
Name:MASON, TEKEAH C (LICSW, LCSW, PHD)
Entity type:Individual
Prefix:
First Name:TEKEAH
Middle Name:C
Last Name:MASON
Suffix:
Gender:F
Credentials:LICSW, LCSW, PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8649 VALLEY DR
Mailing Address - Street 2:
Mailing Address - City:WALDORF
Mailing Address - State:MD
Mailing Address - Zip Code:20603-6147
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:8649 VALLEY DR
Practice Address - Street 2:
Practice Address - City:WALDORF
Practice Address - State:MD
Practice Address - Zip Code:20603-6147
Practice Address - Country:US
Practice Address - Phone:301-970-9735
Practice Address - Fax:301-970-9735
Is Sole Proprietor?:No
Enumeration Date:2010-05-26
Last Update Date:2024-12-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN103T00000X
DCLC500785041041C0700X
MD163101041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No103T00000XBehavioral Health & Social Service ProvidersPsychologist