Healthcare Provider Details

I. General information

NPI: 1306483631
Provider Name (Legal Business Name): THECLA ASOLUKA PMHNP-BC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/05/2019
Last Update Date: 12/18/2025
Certification Date: 12/18/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

100 WEST RD STE 300
TOWSON MD
21204-2370
US

IV. Provider business mailing address

100 WEST RD STE 300
TOWSON MD
21204-2370
US

V. Phone/Fax

Practice location:
  • Phone: 410-801-7822
  • Fax: 410-801-7821
Mailing address:
  • Phone: 410-801-7822
  • Fax: 410-801-7821

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License NumberR143678
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: