Provider Demographics
NPI:1437850443
Name:BELTON, MYIA A (LCSW-C, LICSW)
Entity type:Individual
Prefix:
First Name:MYIA
Middle Name:A
Last Name:BELTON
Suffix:
Gender:F
Credentials:LCSW-C, LICSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:12401 JAMES MADISON LN
Mailing Address - Street 2:
Mailing Address - City:GLENN DALE
Mailing Address - State:MD
Mailing Address - Zip Code:20769-9168
Mailing Address - Country:US
Mailing Address - Phone:240-853-1243
Mailing Address - Fax:
Practice Address - Street 1:12401 JAMES MADISON LN
Practice Address - Street 2:
Practice Address - City:GLENN DALE
Practice Address - State:MD
Practice Address - Zip Code:20769-9168
Practice Address - Country:US
Practice Address - Phone:240-853-1243
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-03-15
Last Update Date:2024-09-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DCCACII200001200101YA0400X
DCLC2000030581041C0700X
MD274661041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)