Provider Demographics
NPI:1174681845
Name:OWENS, ELLERY ALLEN (LCSW C MARYLAND)
Entity type:Individual
Prefix:
First Name:ELLERY
Middle Name:ALLEN
Last Name:OWENS
Suffix:
Gender:F
Credentials:LCSW C MARYLAND
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:50 W MONTGOMERY AVENUE
Mailing Address - Street 2:SUITE 110
Mailing Address - City:ROCKVILLE
Mailing Address - State:MD
Mailing Address - Zip Code:20850-4216
Mailing Address - Country:US
Mailing Address - Phone:301-251-8965
Mailing Address - Fax:301-251-0136
Practice Address - Street 1:AFFILIATED COMMUNITY COUNSELORS INC
Practice Address - Street 2:50 WEST MONTGOMERY AVE SUITE 110
Practice Address - City:ROCKVILLE
Practice Address - State:MD
Practice Address - Zip Code:20850-4216
Practice Address - Country:US
Practice Address - Phone:301-251-8965
Practice Address - Fax:301-251-0136
Is Sole Proprietor?:No
Enumeration Date:2006-12-05
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
103181041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
DC77260026OtherBCBS
MD75853902OtherBCBS
DC77260026OtherBCBS