Individual
MICAH BEASTON
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
1305 DARES BEACH RD, PRINCE FREDERICK, MD 20678-4208
(443) 550-8468
Mailing address
1700 DARES BEACH RD, PRINCE FREDERICK, MD 20678-4236
Taxonomy
Speciality
Code
Description
License number
State
104100000X
Social Worker
Primary
SW129863
PA
Other
Enumeration date
12/21/2020
Last updated
12/21/2020
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