Healthcare Provider Details

I. General information

NPI: 1619746591
Provider Name (Legal Business Name): URBAN INTEGRATED HEALTH SERVICES INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/20/2023
Last Update Date: 12/20/2023
Certification Date: 12/20/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

104 47TH ST NE
WASHINGTON DC
20019-5205
US

IV. Provider business mailing address

104 47TH ST NE
WASHINGTON DC
20019-5205
US

V. Phone/Fax

Practice location:
  • Phone: 240-595-8191
  • Fax:
Mailing address:
  • Phone: 240-595-8191
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number State

VIII. Authorized Official

Name: BERNARD AKINSEYE
Title or Position: CEO
Credential:
Phone: 240-595-8191