Provider Demographics
NPI:1386104156
Name:LECOUNTE, WESLEY (LCSW-C)
Entity type:Individual
Prefix:
First Name:WESLEY
Middle Name:
Last Name:LECOUNTE
Suffix:
Gender:F
Credentials:LCSW-C
Other - Prefix:
Other - First Name:WESLEY
Other - Middle Name:
Other - Last Name:INGRAM
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LCSW-C
Mailing Address - Street 1:923 EASTHAM CT APT 34
Mailing Address - Street 2:
Mailing Address - City:CROFTON
Mailing Address - State:MD
Mailing Address - Zip Code:21114-1034
Mailing Address - Country:US
Mailing Address - Phone:443-970-2689
Mailing Address - Fax:
Practice Address - Street 1:325 GAMBRILLS RD STE F
Practice Address - Street 2:
Practice Address - City:GAMBRILLS
Practice Address - State:MD
Practice Address - Zip Code:21054-1102
Practice Address - Country:US
Practice Address - Phone:443-569-8882
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-03-20
Last Update Date:2019-06-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD210181041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
MDI526870098757OtherDRIVERS LICENSE