Provider Demographics
NPI:1538721170
Name:DEBOLT, CASEY MARIE (LCSW-C)
Entity type:Individual
Prefix:
First Name:CASEY
Middle Name:MARIE
Last Name:DEBOLT
Suffix:
Gender:F
Credentials:LCSW-C
Other - Prefix:
Other - First Name:CASEY
Other - Middle Name:MARIE
Other - Last Name:ANDERSON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LMSW
Mailing Address - Street 1:1307 FORDHAM CT
Mailing Address - Street 2:
Mailing Address - City:BEL AIR
Mailing Address - State:MD
Mailing Address - Zip Code:21014-2006
Mailing Address - Country:US
Mailing Address - Phone:410-961-1886
Mailing Address - Fax:
Practice Address - Street 1:1208 COYOTE CT
Practice Address - Street 2:
Practice Address - City:ABINGDON
Practice Address - State:MD
Practice Address - Zip Code:21009-4312
Practice Address - Country:US
Practice Address - Phone:410-417-7305
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-07-03
Last Update Date:2024-03-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD24930104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker