Healthcare Provider Details

I. General information

NPI: 1144838509
Provider Name (Legal Business Name): YOSAN GEBRE-AB LCPC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/21/2020
Last Update Date: 01/23/2024
Certification Date: 01/23/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1205 YORK RD STE 14
TIMONIUM MD
21093-6211
US

IV. Provider business mailing address

1205 YORK RD STE 14
TIMONIUM MD
21093-6211
US

V. Phone/Fax

Practice location:
  • Phone: 410-757-2077
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License NumberLC14003
License Number StateMD
# 2
Primary TaxonomyN
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License NumberLC14003
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: