Provider Demographics
NPI:1730129370
Name:TITUS, JOSEPH C (LCSW-C)
Entity type:Individual
Prefix:
First Name:JOSEPH
Middle Name:C
Last Name:TITUS
Suffix:
Gender:M
Credentials:LCSW-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:120 BANJO LANE
Mailing Address - Street 2:
Mailing Address - City:CENTREVILLE
Mailing Address - State:MD
Mailing Address - Zip Code:21617
Mailing Address - Country:US
Mailing Address - Phone:410-758-2211
Mailing Address - Fax:410-758-0698
Practice Address - Street 1:120 BANJO LANE
Practice Address - Street 2:
Practice Address - City:CENTREVILLE
Practice Address - State:MD
Practice Address - Zip Code:21617
Practice Address - Country:US
Practice Address - Phone:410-758-2211
Practice Address - Fax:410-758-0698
Is Sole Proprietor?:No
Enumeration Date:2006-06-08
Last Update Date:2017-11-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD173251041C0700X
MDG121511041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD774800100Medicaid