Healthcare Provider Details

I. General information

NPI: 1205748258
Provider Name (Legal Business Name): JOEL OSEBOR
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/22/2026
Last Update Date: 09/22/2026
Certification Date: 09/22/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3060 MITCHELLVILLE RD UNIT 106
BOWIE MD
20716-1389
US

IV. Provider business mailing address

34 DEFENSE ST STE 150
ANNAPOLIS MD
21401-3577
US

V. Phone/Fax

Practice location:
  • Phone: 240-610-5424
  • Fax:
Mailing address:
  • Phone: 240-610-5424
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License NumberLGP18568
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: