Healthcare Provider Details

I. General information

NPI: 1114866431
Provider Name (Legal Business Name): PENUEL BEHAVIORAL HEALTH SERVICES LLC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/25/2026
Last Update Date: 03/25/2026
Certification Date: 03/25/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1636 CEDDOX ST
BALTIMORE MD
21226-1413
US

IV. Provider business mailing address

1636 CEDDOX ST
BALTIMORE MD
21226-1413
US

V. Phone/Fax

Practice location:
  • Phone: 301-635-1240
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License Number
License Number State

VIII. Authorized Official

Name: OLABIMPE OLOJO
Title or Position: OWNER
Credential:
Phone: 301-635-1240