Healthcare Provider Details

I. General information

NPI: 1801706486
Provider Name (Legal Business Name): MAXLINE ACOBTA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/08/2026
Last Update Date: 09/08/2026
Certification Date: 09/08/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

13042 OLD STAGE COACH RD APT 222
LAUREL MD
20708-1612
US

IV. Provider business mailing address

13042 OLD STAGE COACH RD APT 222
LAUREL MD
20708-1612
US

V. Phone/Fax

Practice location:
  • Phone: 240-486-8073
  • Fax:
Mailing address:
  • Phone: 240-486-8073
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101Y00000X
TaxonomyCounselor
License Number123456789
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: