Individual
KOREY J. PUCKETT
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
LICSW
Contact information
Practice address
1629 K ST NW, SUITE 300, WASHINGTON, DC 20006-1602
(410) 236-0028
Mailing address
5815 COMSTOCK AVE, BALTIMORE, MD 21206-2214
(410) 236-0028
Taxonomy
Speciality
Code
Description
License number
State
1041C0700X
Clinical Social Worker
Primary
LC50079247
DC
Other
Enumeration date
01/03/2012
Last updated
01/03/2012
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