Healthcare Provider Details

I. General information

NPI: 1659190478
Provider Name (Legal Business Name): AMEN OKOJIE
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/08/2024
Last Update Date: 10/22/2024
Certification Date: 10/22/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1645 LIBERTY RD
ELDERSBURG MD
21784-6521
US

IV. Provider business mailing address

7524 MAIN ST
SYKESVILLE MD
21784-7594
US

V. Phone/Fax

Practice location:
  • Phone: 443-328-4946
  • Fax:
Mailing address:
  • Phone: 443-328-4946
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License NumberLGP15768
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: