Provider Demographics
NPI:1427832021
Name:DUGAN, JACOB AUSTIN (LMSW)
Entity type:Individual
Prefix:
First Name:JACOB
Middle Name:AUSTIN
Last Name:DUGAN
Suffix:
Gender:M
Credentials:LMSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7132 STONE THROW WAY
Mailing Address - Street 2:
Mailing Address - City:ELKRIDGE
Mailing Address - State:MD
Mailing Address - Zip Code:21075-7902
Mailing Address - Country:US
Mailing Address - Phone:410-660-0527
Mailing Address - Fax:
Practice Address - Street 1:10451 TWIN RIVERS RD STE 100
Practice Address - Street 2:
Practice Address - City:COLUMBIA
Practice Address - State:MD
Practice Address - Zip Code:21044-2332
Practice Address - Country:US
Practice Address - Phone:410-997-3557
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-08-23
Last Update Date:2023-08-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD30527104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker