MEDICARE: NICKY OWUSU

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	101YM0800X	Mental Health Counselor	0704017343	VA

General Provider Information

NPI Number	:	1720910920
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	NICKY OWUSU

Provider Business Mailing Address
First Line	:	384 GREENSTEAD DR
Second Line	:
City	:	STAFFORD
State	:	VA
Zip	:	22554-6595
Country	:	US
Telephone Number	:	866-968-6342
Fax Number	:	855-615-2876

Provider Business Practice Location Address
First Line	:	384 GREENSTEAD DR
Second Line	:
City	:	STAFFORD
State	:	VA
Zip	:	22554-6595
Country	:	US
Telephone Number	:	866-968-6342
Fax Number	:	855-615-2876

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	06/01/2026
Last Update Date	:	06/01/2026

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Directions to “ NICKY OWUSU ” Practice Location

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