Basic Information
| Provider Information | |||||||||
| NPI: | 1730129370 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | TITUS | ||||||||
| FirstName: | JOSEPH | ||||||||
| MiddleName: | C | ||||||||
| NamePrefix: | |||||||||
| NameSuffix: | |||||||||
| Credential: | LCSW-C | ||||||||
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| Mailing Information | |||||||||
| Address1: | 120 BANJO LANE | ||||||||
| Address2: | |||||||||
| City: | CENTREVILLE | ||||||||
| State: | MD | ||||||||
| PostalCode: | 21617 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4107582211 | ||||||||
| FaxNumber: | 4107580698 | ||||||||
| Practice Location | |||||||||
| Address1: | 120 BANJO LANE | ||||||||
| Address2: | |||||||||
| City: | CENTREVILLE | ||||||||
| State: | MD | ||||||||
| PostalCode: | 21617 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4107582211 | ||||||||
| FaxNumber: | 4107580698 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 06/08/2006 | ||||||||
| LastUpdateDate: | 11/15/2017 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 1041C0700X | 17325 | MD | Y | Behavioral Health & Social Service Providers | Social Worker | Clinical | 1041C0700X | G12151 | MD | N | Behavioral Health & Social Service Providers | Social Worker | Clinical |
ID Information
| ID | Type | State | Issuer | Description | 774800100 | 05 | MD | MEDICAID |