Provider Demographics
NPI:1497230064
Name:MEJIA CASTANO, OMAIRA (LCPC)
Entity Type:Individual
Prefix:
First Name:OMAIRA
Middle Name:
Last Name:MEJIA CASTANO
Suffix:
Gender:F
Credentials:LCPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:101 W 27TH ST UNIT 1
Mailing Address - Street 2:
Mailing Address - City:BALTIMORE
Mailing Address - State:MD
Mailing Address - Zip Code:21218-4305
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:3400 CHESTNUT AVE FL 2
Practice Address - Street 2:
Practice Address - City:BALTIMORE
Practice Address - State:MD
Practice Address - Zip Code:21211-2516
Practice Address - Country:US
Practice Address - Phone:917-757-6280
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-09-30
Last Update Date:2019-02-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDLC8680101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health