Healthcare Provider Details

I. General information

NPI: 1487580734
Provider Name (Legal Business Name): JIAZHAO XU
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: MAVIS XU

II. Dates (important events)

Enumeration Date: 06/23/2026
Last Update Date: 06/23/2026
Certification Date: 06/23/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3000 MANCHESTER RD
MANCHESTER MD
21102-1850
US

IV. Provider business mailing address

727 W 40TH ST APT 534
BALTIMORE MD
21211-2354
US

V. Phone/Fax

Practice location:
  • Phone: 410-861-0066
  • Fax:
Mailing address:
  • Phone: 512-720-8470
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: