Healthcare Provider Details

I. General information

NPI: 1912374059
Provider Name (Legal Business Name): SOLOMON OGUINE LCPC
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/24/2015
Last Update Date: 08/24/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3613 WHITE AVE
BALTIMORE MD
21206-3413
US

IV. Provider business mailing address

3613 WHITE AVE
BALTIMORE MD
21206-3413
US

V. Phone/Fax

Practice location:
  • Phone: 443-801-6790
  • Fax: 410-254-0313
Mailing address:
  • Phone: 443-801-6790
  • Fax: 410-254-0313

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License NumberLC6537
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: