Healthcare Provider Details

I. General information

NPI: 1528680873
Provider Name (Legal Business Name): AMY FOEHRKOLB, LCPC LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/09/2020
Last Update Date: 11/19/2025
Certification Date: 11/19/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1116 CORAL CT
ANNAPOLIS MD
21409-4744
US

IV. Provider business mailing address

1116 CORAL CT
ANNAPOLIS MD
21409-4744
US

V. Phone/Fax

Practice location:
  • Phone: 443-794-8336
  • Fax:
Mailing address:
  • Phone: 443-794-8336
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License Number
License Number State

VIII. Authorized Official

Name: AMY FOEHRKOLB
Title or Position: OWNER
Credential: LCPC
Phone: 443-794-8336