Healthcare Provider Details

I. General information

NPI: 1104522994
Provider Name (Legal Business Name): MERCY OBOUR LMSW
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/02/2023
Last Update Date: 02/02/2023
Certification Date: 02/01/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5800 BETSY CIR
WALDORF MD
20601-3301
US

IV. Provider business mailing address

5463 FROGGY BOTTOM LN
FREDERICK MD
21703-7306
US

V. Phone/Fax

Practice location:
  • Phone: 410-934-0580
  • Fax: 410-834-1217
Mailing address:
  • Phone: 240-486-7182
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number29434
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: