Healthcare Provider Details

I. General information

NPI: 1821630377
Provider Name (Legal Business Name): IRENE OPABAJO LGPC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/16/2019
Last Update Date: 01/28/2021
Certification Date: 01/28/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

17904 GEORGIA AVE # 2
OLNEY MD
20832-2239
US

IV. Provider business mailing address

7474 GREENWAY CENTER DR STE 200
GREENBELT MD
20770-3524
US

V. Phone/Fax

Practice location:
  • Phone: 240-304-3327
  • Fax:
Mailing address:
  • Phone: 240-304-3327
  • Fax: 410-609-7091

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101Y00000X
TaxonomyCounselor
License NumberLGP9597
License Number StateMD
# 2
Primary TaxonomyN
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License NumberLGP9597
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: