Healthcare Provider Details

I. General information

NPI: 1528524428
Provider Name (Legal Business Name): ANN GI HUN PAK YIP LGPC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/15/2019
Last Update Date: 02/21/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10632 LITTLE PATUXENT PKWY
COLUMBIA MD
21044-3273
US

IV. Provider business mailing address

10530 RESORT RD UNIT 205
ELLICOTT CITY MD
21042-2492
US

V. Phone/Fax

Practice location:
  • Phone: 443-864-5647
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License NumberLGP8684
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: