Healthcare Provider Details

I. General information

NPI: 1578499612
Provider Name (Legal Business Name): ANISSA CHEIKH
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/18/2026
Last Update Date: 09/29/2026
Certification Date: 09/29/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1401 MERCANTILE LN STE 500A
UPPER MARLBORO MD
20774-4301
US

IV. Provider business mailing address

1401 MERCANTILE LN # 500A
UPPER MARLBORO MD
20774-4301
US

V. Phone/Fax

Practice location:
  • Phone: 202-746-5838
  • Fax:
Mailing address:
  • Phone: 202-746-5838
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License NumberLGP18015
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: