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General NPI Number Information
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NPI Number | 1396217741
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Entity Type | Organization
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Legal Business Name | LISA M. OTT, LCSW-C, LLC
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Dates
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Enumeration Date | 12/26/2018
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Last Update Date | 12/26/2018
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Provider Practice Location Address
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Address Line | 8640 GUILFORD RD STE 252
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City | COLUMBIA
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State | MD
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Zip | 21046-2666
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Country | US
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Telephone | 410-440-5828
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Fax | 410-312-7298
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Provider Business Mailing Address
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Address Line | 9643 GREEN MOON PATH
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City | COLUMBIA
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State | MD
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Zip | 21046-2069
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Country | US
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Telephone | 410-440-5828
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | MS. LISA M OTT
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Credential | MSW, LCSW-C
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Telephone | 410-440-5828
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 251S00000X
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Taxonomy Name | Community/Behavioral Health Agency
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License Number |
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License Number State |
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