Healthcare Provider Details

I. General information

NPI: 1609460419
Provider Name (Legal Business Name): ANGIE WIRSING LGPC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/22/2021
Last Update Date: 12/29/2025
Certification Date: 12/29/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9627 PHILADELPHIA RD STE 160
ROSEDALE MD
21237-4157
US

IV. Provider business mailing address

414 OVERBROOK RD
CATONSVILLE MD
21228-1823
US

V. Phone/Fax

Practice location:
  • Phone: 410-780-5203
  • Fax:
Mailing address:
  • Phone: 240-712-4741
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License NumberLGP9709
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: