Healthcare Provider Details

I. General information

NPI: 1174342547
Provider Name (Legal Business Name): HONOUR THYSELF COUNSELING & PSYCHOLOGICAL SERVICES, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/03/2024
Last Update Date: 11/24/2024
Certification Date: 11/24/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7404 EXECUTIVE PL
LANHAM MD
20706-2268
US

IV. Provider business mailing address

1121 ANNAPOLIS RD # 174
ODENTON MD
21113-1633
US

V. Phone/Fax

Practice location:
  • Phone: 443-484-8336
  • Fax:
Mailing address:
  • Phone: 443-484-8336
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code103T00000X
TaxonomyPsychologist
License Number
License Number State

VIII. Authorized Official

Name: DR. BIANCA FETHERSON
Title or Position: OWNER
Credential: PH.D. LP
Phone: 443-484-8336