Provider Demographics
NPI:1104522994
Name:OBOUR, MERCY (LMSW)
Entity type:Individual
Prefix:
First Name:MERCY
Middle Name:
Last Name:OBOUR
Suffix:
Gender:F
Credentials:LMSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5463 FROGGY BOTTOM LN
Mailing Address - Street 2:
Mailing Address - City:FREDERICK
Mailing Address - State:MD
Mailing Address - Zip Code:21703-7306
Mailing Address - Country:US
Mailing Address - Phone:240-486-7182
Mailing Address - Fax:
Practice Address - Street 1:5800 BETSY CIR
Practice Address - Street 2:
Practice Address - City:WALDORF
Practice Address - State:MD
Practice Address - Zip Code:20601-3301
Practice Address - Country:US
Practice Address - Phone:410-934-0580
Practice Address - Fax:410-834-1217
Is Sole Proprietor?:No
Enumeration Date:2023-02-02
Last Update Date:2023-02-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD29434101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health