Healthcare Provider Details

I. General information

NPI: 1518799279
Provider Name (Legal Business Name): AMY OGBUAKU
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/20/2024
Last Update Date: 12/12/2025
Certification Date: 12/12/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

903 BRIGHTSEAT RD
LANDOVER MD
20785-4725
US

IV. Provider business mailing address

1405 BERMUDA DUNES CT
BOWIE MD
20721-3114
US

V. Phone/Fax

Practice location:
  • Phone: 301-333-2980
  • Fax:
Mailing address:
  • Phone: 301-789-6542
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License NumberLGPC200001800
License Number StateDC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: