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General NPI Number Information
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NPI Number | 1285590612
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Entity Type | Individual
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Provider Name | ANGELA RENISHA OMOOGUN LGPC
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Gender | Female
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Dates
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Enumeration Date | 12/30/2025
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Last Update Date | 12/30/2025
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Provider Practice Location Address
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Address Line | 6212 YORK RD
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City | BALTIMORE
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State | MD
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Zip | 21212-2612
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Country | US
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Telephone | 410-878-1085
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Fax | 443-388-9909
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Provider Business Mailing Address
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Address Line | 4724 WINTERSET WAY
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City | OWINGS MILLS
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State | MD
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Zip | 21117-4756
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 101YM0800X
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Taxonomy Name | Mental Health Counselor
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License Number | LGP17375
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License Number State | MD
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