Healthcare Provider Details

I. General information

NPI: 1518780451
Provider Name (Legal Business Name): ANTHONIA AMALU
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/07/2024
Last Update Date: 07/04/2026
Certification Date: 07/04/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6201 GREENBELT RD
BERWYN HEIGHTS MD
20740-2354
US

IV. Provider business mailing address

2701 PRINCESS VICTORIA WAY
BOWIE MD
20721-2439
US

V. Phone/Fax

Practice location:
  • Phone: 301-747-7038
  • Fax: 301-517-7403
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License NumberLGP18048
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: