Healthcare Provider Details

I. General information

NPI: 1114639739
Provider Name (Legal Business Name): AUSTIN CHARLES OCHU LCPC
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/14/2022
Last Update Date: 12/14/2022
Certification Date: 12/10/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3623 FALLS RD
BALTIMORE MD
21211-1815
US

IV. Provider business mailing address

1821 MORNING BROOK DR
FOREST HILL MD
21050-2629
US

V. Phone/Fax

Practice location:
  • Phone: 141-093-5257
  • Fax: 410-275-0983
Mailing address:
  • Phone: 410-935-2572
  • Fax: 410-275-0983

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License NumberLC9403
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: