Healthcare Provider Details

I. General information

NPI: 1841156494
Provider Name (Legal Business Name): SUPPORT CARE LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/29/2025
Last Update Date: 12/29/2025
Certification Date: 12/28/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5609 PINE BLUFF CT
FREDERICK MD
21704-6894
US

IV. Provider business mailing address

5609 PINE BLUFF CT
FREDERICK MD
21704-6894
US

V. Phone/Fax

Practice location:
  • Phone: 240-765-5159
  • Fax:
Mailing address:
  • Phone: 240-765-5159
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License Number
License Number State

VIII. Authorized Official

Name: MRS. RENIE EFUETNGU LEKE TAZISONG
Title or Position: PMHNP-PMH
Credential: PMHNP-BC
Phone: 240-765-5159