Provider Demographics
NPI:1427675065
Name:TOMLIN, KHAMEELAH L (LCSW-C)
Entity type:Individual
Prefix:
First Name:KHAMEELAH
Middle Name:L
Last Name:TOMLIN
Suffix:
Gender:F
Credentials:LCSW-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:14240 W SIDE BLVD APT 208
Mailing Address - Street 2:
Mailing Address - City:LAUREL
Mailing Address - State:MD
Mailing Address - Zip Code:20707-6237
Mailing Address - Country:US
Mailing Address - Phone:301-915-4133
Mailing Address - Fax:
Practice Address - Street 1:14240 W SIDE BLVD APT 208
Practice Address - Street 2:
Practice Address - City:LAUREL
Practice Address - State:MD
Practice Address - Zip Code:20707-6237
Practice Address - Country:US
Practice Address - Phone:301-915-4133
Practice Address - Fax:301-560-5558
Is Sole Proprietor?:No
Enumeration Date:2020-06-30
Last Update Date:2021-03-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD235141041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical