Healthcare Provider Details

I. General information

NPI: 1578149571
Provider Name (Legal Business Name): BREANNA FAIR-MCCALL LCPC, RPT
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/20/2021
Last Update Date: 12/17/2025
Certification Date: 12/17/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2919 OLNEY SANDY SPRING RD STE C
OLNEY MD
20832-1588
US

IV. Provider business mailing address

2919 OLNEY SANDY SPRING RD STE C
OLNEY MD
20832-1588
US

V. Phone/Fax

Practice location:
  • Phone: 240-476-3935
  • Fax:
Mailing address:
  • Phone: 240-476-3935
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License NumberLC11011
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: