Healthcare Provider Details

I. General information

NPI: 1093594194
Provider Name (Legal Business Name): HEPATOALLAH YOUSSEF
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/27/2023
Last Update Date: 06/08/2026
Certification Date: 06/08/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3525H ELLICOTT MILLS DR STE 105
ELLICOTT CITY MD
21043-4544
US

IV. Provider business mailing address

3525 ELLICOTT MILLS DR STE H105
ELLICOTT CITY MD
21043-4506
US

V. Phone/Fax

Practice location:
  • Phone: 410-429-0539
  • Fax:
Mailing address:
  • Phone: 410-429-0539
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License NumberLC17744
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: