Healthcare Provider Details

I. General information

NPI: 1306662341
Provider Name (Legal Business Name): POLLYNE G NAKABUYE LGPC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/25/2024
Last Update Date: 05/20/2025
Certification Date: 05/20/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4000 BLACKBURN LN STE 150
BURTONSVILLE MD
20866-6127
US

IV. Provider business mailing address

4000 BLACKBURN LN STE 150
BURTONSVILLE MD
20866-6127
US

V. Phone/Fax

Practice location:
  • Phone: 301-421-4241
  • Fax:
Mailing address:
  • Phone: 301-421-4241
  • Fax: 410-696-3696

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YS0200X
TaxonomySchool Counselor
License NumberLGP14681
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: