=====================================================
General NPI Number Information
=====================================================
NPI Number | 1558252999
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | YUNCHAO LIU
-----------------------------------------------------
Gender | Male
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 07/14/2025
-----------------------------------------------------
Last Update Date | 07/14/2025
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 601 BALTIMORE ANNAPOLIS BLVD
-----------------------------------------------------
City | SEVERNA PARK
-----------------------------------------------------
State | MD
-----------------------------------------------------
Zip | 21146-3970
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 410-553-4450
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 1 E UNIVERSITY PKWY UNIT 210
-----------------------------------------------------
City | BALTIMORE
-----------------------------------------------------
State | MD
-----------------------------------------------------
Zip | 21218-2417
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 813-600-9636
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 101Y00000X
-----------------------------------------------------
Taxonomy Name | Counselor
-----------------------------------------------------
License Number | LGP16705
-----------------------------------------------------
License Number State | MD
-----------------------------------------------------