Healthcare Provider Details

I. General information

NPI: 1891336061
Provider Name (Legal Business Name): JAALAH-AI HEUGHAN LCPC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/30/2019
Last Update Date: 09/17/2021
Certification Date: 09/17/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4 POMONA W APT 10
PIKESVILLE MD
21208-2950
US

IV. Provider business mailing address

4 POMONA W APT 10
PIKESVILLE MD
21208-2950
US

V. Phone/Fax

Practice location:
  • Phone: 410-900-9064
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License NumberLC11919
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: