Healthcare Provider Details

I. General information

NPI: 1467079889
Provider Name (Legal Business Name): LAKITHA OWENS PHD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/01/2020
Last Update Date: 01/29/2026
Certification Date: 01/29/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3261 OLD WASHINGTON RD STE 2020
WALDORF MD
20602-3231
US

IV. Provider business mailing address

3261 OLD WASHINGTON RD STE 2020
WALDORF MD
20602-3231
US

V. Phone/Fax

Practice location:
  • Phone: 240-435-2524
  • Fax:
Mailing address:
  • Phone: 240-435-2524
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License NumberPRC200001300
License Number StateDC
# 2
Primary TaxonomyN
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License NumberPSY200001772
License Number StateDC
# 3
Primary TaxonomyY
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License Number0810008211
License Number StateVA
# 4
Primary TaxonomyN
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License Number07525
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: