Healthcare Provider Details

I. General information

NPI: 1760199863
Provider Name (Legal Business Name): MLJ COUNSELING & CONSULTING FIRM, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/31/2022
Last Update Date: 12/15/2022
Certification Date: 12/15/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1612 PROFESSIONAL BLVD STE A
CROFTON MD
21114-2049
US

IV. Provider business mailing address

1612 PROFESSIONAL BLVD STE A
CROFTON MD
21114-2049
US

V. Phone/Fax

Practice location:
  • Phone: 443-203-8508
  • Fax:
Mailing address:
  • Phone: 443-203-8508
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number
License Number State

VIII. Authorized Official

Name: OLUBUSOLA SARI
Title or Position: CHIEF EXECUTIVE OFFICER
Credential: LCSW-C
Phone: 443-203-8508