Healthcare Provider Details

I. General information

NPI: 1548919525
Provider Name (Legal Business Name): OSCAR A MEJIA CRUZ LCPC
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/18/2022
Last Update Date: 03/23/2023
Certification Date: 03/23/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1726 WHITEHEAD RD
WOODLAWN MD
21207-4003
US

IV. Provider business mailing address

108 CHENOWETH LN
LA VERGNE TN
37086-2652
US

V. Phone/Fax

Practice location:
  • Phone: 410-265-8737
  • Fax:
Mailing address:
  • Phone: 443-939-9207
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number10551
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: