Healthcare Provider Details

I. General information

NPI: 1982941472
Provider Name (Legal Business Name): TYNIA OKOH-ESENE LCPC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/03/2013
Last Update Date: 09/15/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2203 E CHASE ST
BALTIMORE MD
21213-3406
US

IV. Provider business mailing address

9811 BIGGS RD
BALTIMORE MD
21220-3881
US

V. Phone/Fax

Practice location:
  • Phone: 443-869-4034
  • Fax: 443-869-4056
Mailing address:
  • Phone: 410-905-5071
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License NumberLC7190
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: