NPIMap

Individual provider Active NPI

Etchu Abunaw

  • Mental Health Counselor
  • Baltimore, MD
National Provider Identifier
1063204030
Registry record updated Nov 24, 2025
On this page

Key facts

NPPES NPI Registry
Primary specialty
Mental Health CounselorTaxonomy code 101YM0800X
License
LC17228 Issued in MD
Practice address
828 Guilford Ave
Baltimore, MD 21202-3707
Phone
(443) 854-5033
NPI assigned
May 19, 2025
Last updated
Nov 24, 2025By the provider in NPPES
Sex
Male
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Nov 24, 2025

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Mental Health Counselor 101YM0800X LC17228 MD Primary

Addresses

Primary practice location

828 Guilford Ave
Baltimore, MD 21202-3707

Mailing address

5403 Gradin Ave
Gwynn Oak
Baltimore, MD 21207-6109
Phone (443) 854-5033

Other practice location 1

5403 Gradin Ave
Gwynn Oak
Baltimore, MD 21207-6109
Phone (443) 854-5033

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Not listed in the public Medicare enrollment file

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Not enrolled

State licenses

LicenseStateTypeSpecialty
LC17228MDMDMental Health Counselor

Practice roles

OrganizationSpecialtyStatusNew patients
Henry Recovery House and Mental Health Therapy LLC Current Accepting new patients

Organizations & group practices 5

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1747612800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1763942400000",
    "number": "1063204030",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "5403 GRADIN AVE",
            "address_2": "GWYNN OAK",
            "city": "BALTIMORE",
            "state": "MD",
            "postal_code": "212076109",
            "telephone_number": "443-854-5033",
            "fax_number": "443-854-5033"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "828 GUILFORD AVE",
            "city": "BALTIMORE",
            "state": "MD",
            "postal_code": "212023707",
            "telephone_number": "443-854-5033"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "5403 Gradin Ave",
            "address_2": "Gwynn Oak",
            "address_purpose": "LOCATION",
            "city": "Baltimore",
            "state": "MD",
            "postal_code": "212076109",
            "country_code": "US",
            "telephone_number": "443-854-5033",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "ABUNAW",
        "first_name": "ETCHU",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2025-05-19",
        "last_updated": "2025-11-24",
        "certification_date": "2025-11-24",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "101YM0800X",
            "taxonomy_group": "",
            "desc": "Counselor, Mental Health",
            "state": "MD",
            "license": "LC17228",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Baltimore, MD

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 24, 2025; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.