Healthcare Provider Details

I. General information

NPI: 1033413927
Provider Name (Legal Business Name): LEE F. OWENS, ED.D.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/06/2011
Last Update Date: 01/06/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

116 DEFENSE HWY SUITE 210
ANNAPOLIS MD
21401-7027
US

IV. Provider business mailing address

212 BALSAM TREE CT
SEVERNA PARK MD
21146-2852
US

V. Phone/Fax

Practice location:
  • Phone: 410-224-2021
  • Fax: 410-224-2420
Mailing address:
  • Phone: 410-224-2021
  • Fax: 410-224-2420

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TC1900X
TaxonomyCounseling Psychologist
License Number02540
License Number StateMD

VIII. Authorized Official

Name: DR. LEE F. OWENS
Title or Position: OWNER
Credential: ED.D.
Phone: 410-224-2021