Provider Demographics
NPI:1760468755
Name:DEVAUGHN, ANNE L (LCSW-C, LMFT)
Entity type:Individual
Prefix:
First Name:ANNE
Middle Name:L
Last Name:DEVAUGHN
Suffix:
Gender:F
Credentials:LCSW-C, LMFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:435 INDEPENDENCE ST
Mailing Address - Street 2:
Mailing Address - City:CUMBERLAND
Mailing Address - State:MD
Mailing Address - Zip Code:21502-1611
Mailing Address - Country:US
Mailing Address - Phone:301-777-8779
Mailing Address - Fax:
Practice Address - Street 1:900 SETON DR
Practice Address - Street 2:SECOND FLOOR
Practice Address - City:CUMBERLAND
Practice Address - State:MD
Practice Address - Zip Code:21502-1854
Practice Address - Country:US
Practice Address - Phone:301-723-1443
Practice Address - Fax:301-723-1480
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-12-21
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD107061041C0700X
MDLCM029106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Not Answered106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist