=====================================================
General NPI Number Information
=====================================================
NPI Number | 1063170926
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | FATIMA IBRAHIM HASSAN LCPC
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 12/07/2021
-----------------------------------------------------
Last Update Date | 10/26/2023
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 1900 E NORTHERN PKWY STE 110
-----------------------------------------------------
City | BALTIMORE
-----------------------------------------------------
State | MD
-----------------------------------------------------
Zip | 21239-2113
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 443-438-7166
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 13137 COUNTRY RIDGE DR
-----------------------------------------------------
City | GERMANTOWN
-----------------------------------------------------
State | MD
-----------------------------------------------------
Zip | 20874-1129
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 240-702-4051
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 101YP2500X
-----------------------------------------------------
Taxonomy Name | Professional Counselor
-----------------------------------------------------
License Number | LC14514
-----------------------------------------------------
License Number State | MD
-----------------------------------------------------