Healthcare Provider Details

I. General information

NPI: 1770492555
Provider Name (Legal Business Name): FOURROOTS WELLNESS AND CONSULTING GROUP, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/05/2026
Last Update Date: 09/05/2026
Certification Date: 09/05/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10007 CAMPUS WAY S
UPPER MARLBORO MD
20774-2103
US

IV. Provider business mailing address

10007 CAMPUS WAY S
UPPER MARLBORO MD
20774-2103
US

V. Phone/Fax

Practice location:
  • Phone: 240-705-3032
  • Fax:
Mailing address:
  • Phone: 240-705-3032
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number State

VIII. Authorized Official

Name: DR. CHIOMA K OPARA
Title or Position: THERAPIST
Credential: LGPC
Phone: 240-705-3032