Healthcare Provider Details

I. General information

NPI: 1033320635
Provider Name (Legal Business Name): MARGARET O'BRIEN LC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: PEGGY O'BRIEN LC

II. Dates (important events)

Enumeration Date: 05/24/2007
Last Update Date: 11/05/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10123 SENATE DR SUPPORT SERVICES
LANHAM MD
20706-4367
US

IV. Provider business mailing address

10123 SENATE DR
LANHAM MD
20706-4367
US

V. Phone/Fax

Practice location:
  • Phone: 301-459-9840
  • Fax: 301-459-9110
Mailing address:
  • Phone: 301-459-9118
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number0369
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: