Healthcare Provider Details

I. General information

NPI: 1710899273
Provider Name (Legal Business Name): ANNAGRACE CENTER FOR BEHAVIORAL HEALTH LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/21/2026
Last Update Date: 09/21/2026
Certification Date: 09/20/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2701 PRINCESS VICTORIA WAY
BOWIE MD
20721-2439
US

IV. Provider business mailing address

2701 PRINCESS VICTORIA WAY
BOWIE MD
20721-2439
US

V. Phone/Fax

Practice location:
  • Phone: 240-646-4368
  • Fax:
Mailing address:
  • Phone: 240-646-4368
  • 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: DR. ANTHONIA OBIANUJU AMALU
Title or Position: CHIEF EXECUTIVE OFFICER
Credential: DR.
Phone: 240-646-4368