Healthcare Provider Details

I. General information

NPI: 1780379263
Provider Name (Legal Business Name): SARA PIRMOHAMED LCPC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/10/2023
Last Update Date: 09/16/2024
Certification Date: 09/16/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

108 OLD SOLOMONS ISLAND RD STE A
ANNAPOLIS MD
21401-0920
US

IV. Provider business mailing address

1002 EAGLE PASSAGES CT
DAVIDSONVILLE MD
21035-1239
US

V. Phone/Fax

Practice location:
  • Phone: 443-214-5097
  • Fax: 443-440-5782
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License NumberLC15237
License Number StateMD
# 2
Primary TaxonomyN
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License NumberLGP8631
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: