Healthcare Provider Details

I. General information

NPI: 1114704590
Provider Name (Legal Business Name): EMMA KATHERINE LEBO
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/11/2023
Last Update Date: 05/31/2025
Certification Date: 05/31/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

20410 OBSERVATION DR STE 108
GERMANTOWN MD
20876-6419
US

IV. Provider business mailing address

8120 WOODMONT AVE STE 840
BETHESDA MD
20814-2789
US

V. Phone/Fax

Practice location:
  • Phone: 240-296-5862
  • Fax:
Mailing address:
  • Phone: 240-618-2889
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: