Healthcare Provider Details

I. General information

NPI: 1689330698
Provider Name (Legal Business Name): GEORGE NGIGE NJOGU
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/14/2021
Last Update Date: 03/30/2023
Certification Date: 03/30/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

200 BOOTH ST
ELKTON MD
21921-5657
US

IV. Provider business mailing address

71 FLINT DR # MD21901
NORTH EAST MD
21901-3746
US

V. Phone/Fax

Practice location:
  • Phone: 410-996-3400
  • Fax:
Mailing address:
  • Phone: 443-553-5908
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License NumberLGP12109
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: