Healthcare Provider Details

I. General information

NPI: 1275768152
Provider Name (Legal Business Name): YULIYA T RUSABROVA LCPC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/21/2009
Last Update Date: 09/02/2026
Certification Date: 09/02/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

411 KENDIGS MILL RD
OWINGS MILLS MD
21117-1385
US

IV. Provider business mailing address

411 KENDIGS MILL RD
OWINGS MILLS MD
21117-1385
US

V. Phone/Fax

Practice location:
  • Phone: 443-690-5896
  • Fax:
Mailing address:
  • Phone: 443-690-5896
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License NumberLC2219
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: