Healthcare Provider Details

I. General information

NPI: 1306757067
Provider Name (Legal Business Name): KEVIN WILLIAM O'FARRELL LGPC
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/14/2026
Last Update Date: 09/14/2026
Certification Date: 09/14/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8894 STANFORD BLVD
COLUMBIA MD
21045-4794
US

IV. Provider business mailing address

3827 GLENARM AVE
BALTIMORE MD
21206-2407
US

V. Phone/Fax

Practice location:
  • Phone: 646-535-8260
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License NumberLGP18492
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: