Provider Demographics
NPI:1184169765
Name:LACOUR, MAHOGANY (MSW, CADC, LCSW)
Entity type:Individual
Prefix:MRS
First Name:MAHOGANY
Middle Name:
Last Name:LACOUR
Suffix:
Gender:F
Credentials:MSW, CADC, LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4197 WINDFLOWER CT
Mailing Address - Street 2:
Mailing Address - City:WOODBRIDGE
Mailing Address - State:VA
Mailing Address - Zip Code:22193-5100
Mailing Address - Country:US
Mailing Address - Phone:770-658-6337
Mailing Address - Fax:
Practice Address - Street 1:8688 WHEATFIELD WAY
Practice Address - Street 2:
Practice Address - City:ELLICOTT CITY
Practice Address - State:MD
Practice Address - Zip Code:21043-6553
Practice Address - Country:US
Practice Address - Phone:770-658-6337
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-01-05
Last Update Date:2024-07-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GACSW0059261041C0700X
VA09040097911041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical