Provider Demographics
NPI:1538904685
Name:THISTLEWAITE, GRAEME (LMSW)
Entity type:Individual
Prefix:
First Name:GRAEME
Middle Name:
Last Name:THISTLEWAITE
Suffix:
Gender:M
Credentials:LMSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10630 LITTLE PATUXENT PKWY STE AND209A
Mailing Address - Street 2:
Mailing Address - City:COLUMBIA
Mailing Address - State:MD
Mailing Address - Zip Code:21044-3264
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:410-740-8068
Practice Address - Street 1:10630 LITTLE PATUXENT PKWY STE AND209A
Practice Address - Street 2:
Practice Address - City:COLUMBIA
Practice Address - State:MD
Practice Address - Zip Code:21044-3264
Practice Address - Country:US
Practice Address - Phone:410-740-8066
Practice Address - Fax:410-740-8068
Is Sole Proprietor?:No
Enumeration Date:2024-06-29
Last Update Date:2024-06-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker