Provider Demographics
NPI:1801571351
Name:CHURCH, BRIANNA ALYSSA (LMSW)
Entity type:Individual
Prefix:
First Name:BRIANNA
Middle Name:ALYSSA
Last Name:CHURCH
Suffix:
Gender:F
Credentials:LMSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:26765 MORGANZA TURNER RD
Mailing Address - Street 2:
Mailing Address - City:MECHANICSVLLE
Mailing Address - State:MD
Mailing Address - Zip Code:20659-5400
Mailing Address - Country:US
Mailing Address - Phone:240-538-8868
Mailing Address - Fax:
Practice Address - Street 1:603 POST OFFICE RD STE 106
Practice Address - Street 2:
Practice Address - City:WALDORF
Practice Address - State:MD
Practice Address - Zip Code:20602-1914
Practice Address - Country:US
Practice Address - Phone:240-558-8191
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-06-21
Last Update Date:2023-06-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD30235104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker