Healthcare Provider Details

I. General information

NPI: 1235880899
Provider Name (Legal Business Name): UZOMA OPAIGBEOGU BA, MS, MDIV, DMIN
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/15/2022
Last Update Date: 01/15/2022
Certification Date: 01/15/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8929 FOOTED RDG
COLUMBIA MD
21045-4216
US

IV. Provider business mailing address

8929 FOOTED RDG
COLUMBIA MD
21045-4216
US

V. Phone/Fax

Practice location:
  • Phone: 301-526-5927
  • Fax:
Mailing address:
  • Phone: 301-526-5927
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License NumberLC11892
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: