Healthcare Provider Details

I. General information

NPI: 1629535893
Provider Name (Legal Business Name): MIAH HURST LPC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/25/2019
Last Update Date: 08/12/2022
Certification Date: 08/01/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

820 HARLEM AVENUE
BALTIMORE MD
21201
US

IV. Provider business mailing address

820 HARLEM AVE
BALTIMORE MD
21201-1407
US

V. Phone/Fax

Practice location:
  • Phone: 202-759-6107
  • Fax:
Mailing address:
  • Phone: 609-206-6118
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License NumberLGPC00488
License Number StateDC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: