Healthcare Provider Details

I. General information

NPI: 1679344287
Provider Name (Legal Business Name): MCCAY MARTIN MOIFORAY ED.D, LGPC, MPH, CHE
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/11/2024
Last Update Date: 05/11/2026
Certification Date: 05/11/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6901 SECURITY BLVD STE 200
WINDSOR MILL MD
21244-2412
US

IV. Provider business mailing address

9524 MEADOWS FARM DR
OWINGS MILLS MD
21117-4887
US

V. Phone/Fax

Practice location:
  • Phone: 410-837-2050
  • Fax:
Mailing address:
  • Phone: 443-379-7593
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License NumberLC16951
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: