Healthcare Provider Details

I. General information

NPI: 1598523359
Provider Name (Legal Business Name): ONGISA ICHILE-MCKENZIE
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/07/2024
Last Update Date: 03/27/2026
Certification Date: 03/27/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8403 COLESVILLE RD STE 1100
SILVER SPRING MD
20910-6346
US

IV. Provider business mailing address

1203 FIDLER LN APT 908
SILVER SPRING MD
20910-7407
US

V. Phone/Fax

Practice location:
  • Phone: 240-334-7444
  • Fax:
Mailing address:
  • Phone: 240-640-9577
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License NumberLCM1195
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: