Healthcare Provider Details

I. General information

NPI: 1245078427
Provider Name (Legal Business Name): ESWENI IKEIN LGPC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/19/2024
Last Update Date: 07/19/2024
Certification Date: 07/19/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7658 BELAIR RD
NOTTINGHAM MD
21236-4020
US

IV. Provider business mailing address

3044 CALIFORNIA AVE
PARKVILLE MD
21234-4141
US

V. Phone/Fax

Practice location:
  • Phone: 410-800-2169
  • Fax:
Mailing address:
  • Phone: 646-413-1679
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License NumberLGP14666
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: