Basic Information
| Provider Information | |||||||||
| NPI: | 1427675065 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | TOMLIN | ||||||||
| FirstName: | KHAMEELAH | ||||||||
| MiddleName: | L | ||||||||
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| Credential: | LCSW-C | ||||||||
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| Mailing Information | |||||||||
| Address1: | 14240 W SIDE BLVD APT 208 | ||||||||
| Address2: | |||||||||
| City: | LAUREL | ||||||||
| State: | MD | ||||||||
| PostalCode: | 207076237 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3019154133 | ||||||||
| FaxNumber: | |||||||||
| Practice Location | |||||||||
| Address1: | 14240 W SIDE BLVD APT 208 | ||||||||
| Address2: | |||||||||
| City: | LAUREL | ||||||||
| State: | MD | ||||||||
| PostalCode: | 207076237 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3019154133 | ||||||||
| FaxNumber: | 3015605558 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 06/30/2020 | ||||||||
| LastUpdateDate: | 03/10/2021 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 03/10/2021 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 1041C0700X | 23514 | MD | Y | Behavioral Health & Social Service Providers | Social Worker | Clinical |
No ID Information.