Provider Demographics
NPI:1851738835
Name:OWOBU, EMMANUELLA (LCPC)
Entity Type:Individual
Prefix:
First Name:EMMANUELLA
Middle Name:
Last Name:OWOBU
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 1:403 EASTERN BLVD
Mailing Address - Street 2:
Mailing Address - City:ESSEX
Mailing Address - State:MD
Mailing Address - Zip Code:21221-6715
Mailing Address - Country:US
Mailing Address - Phone:443-912-4612
Mailing Address - Fax:877-288-4626
Practice Address - Street 1:403 EASTERN BLVD
Practice Address - Street 2:
Practice Address - City:ESSEX
Practice Address - State:MD
Practice Address - Zip Code:21221-6715
Practice Address - Country:US
Practice Address - Phone:443-912-4612
Practice Address - Fax:877-288-4626
Is Sole Proprietor?:Yes
Enumeration Date:2013-05-30
Last Update Date:2023-06-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDLC4839101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD065881200Medicaid