Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 101YM0800X | Mental Health Counselor | LC2059 | MD |
NPI | 1992984520 |
---|---|
Provider Name | Ms. Ana Milena Olaciregui |
First Address | Silver Spring, MD 20901-4550 |
Second Address | Silver Spring, MD 20901-4550 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 31/10/2007 |
Last Update Date | 14/01/2010 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
LC2059 | (05) | MD |