Provider Demographics
NPI:1285938373
Name:OCHIENG, BEATRICE A (MS, LCPC)
Entity type:Individual
Prefix:MRS
First Name:BEATRICE
Middle Name:A
Last Name:OCHIENG
Suffix:
Gender:F
Credentials:MS, LCPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:417 TANEY DR
Mailing Address - Street 2:
Mailing Address - City:TANEYTOWN
Mailing Address - State:MD
Mailing Address - Zip Code:21787-2249
Mailing Address - Country:US
Mailing Address - Phone:443-547-0091
Mailing Address - Fax:
Practice Address - Street 1:198 THOMAS JOHNSON DR STE 9
Practice Address - Street 2:
Practice Address - City:FREDERICK
Practice Address - State:MD
Practice Address - Zip Code:21702-4443
Practice Address - Country:US
Practice Address - Phone:410-756-0383
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-01-04
Last Update Date:2018-11-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
101YP2500X, 103K00000X
MDLGP6207101YP2500X
MDLC8296101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
No103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD01042011136821Medicaid