Healthcare Provider Details

I. General information

NPI: 1437659562
Provider Name (Legal Business Name): LA SHAWNA A OBAME LGPC, NCC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/15/2018
Last Update Date: 09/27/2020
Certification Date: 09/27/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10451 TWIN RIVERS RD STE 100
COLUMBIA MD
21044
US

IV. Provider business mailing address

4623 FALLS RD
BALTIMORE MD
21209-4914
US

V. Phone/Fax

Practice location:
  • Phone: 410-997-3557
  • Fax: 410-964-1791
Mailing address:
  • Phone: 410-366-1980
  • Fax: 410-366-8530

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License NumberLGP7464
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: