Healthcare Provider Details

I. General information

NPI: 1164092375
Provider Name (Legal Business Name): MRS. OLUWATOSIN TOSIN M TAYLOR
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/29/2021
Last Update Date: 06/29/2021
Certification Date: 06/29/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10104 SENATE DR STE 22220772
LANHAM MD
20706-4392
US

IV. Provider business mailing address

16112 MCCONNELL DR # 20772
UPPER MARLBORO MD
20772-3283
US

V. Phone/Fax

Practice location:
  • Phone: 240-432-0286
  • Fax: 240-523-9876
Mailing address:
  • Phone: 240-432-0286
  • Fax: 240-523-9876

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: