Individual
GWENDOLYN MELLOTT
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
LCSWC
Contact information
Practice address
13215 BROOK LANE, HAGERSTOWN, MD 21742-1514
(301) 733-0331
(301) 733-4038
Mailing address
13121 BROOK LANE, HAGERSTOWN, MD 21742-1514
(301) 733-0331
(301) 733-4038
Taxonomy
Speciality
Code
Description
License number
State
1041C0700X
Clinical Social Worker
Primary
10663
MD
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
986965400
—
MD
Enumeration date
02/24/2006
Last updated
02/20/2018
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