Healthcare Provider Details

I. General information

NPI: 1730066416
Provider Name (Legal Business Name): PEACEFUL HEALING THERAPEUTIC SERVICES LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/16/2025
Last Update Date: 12/21/2025
Certification Date: 12/21/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

12530 FAIRWOOD PKWY
BOWIE MD
20720-6356
US

IV. Provider business mailing address

12530 FAIRWOOD PKWY STE 102 #1147
BOWIE MD
20720-6357
US

V. Phone/Fax

Practice location:
  • Phone: 202-656-3734
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251S00000X
TaxonomyCommunity/Behavioral Health Agency
License Number
License Number State

VIII. Authorized Official

Name: BRONTE' VAUGHN
Title or Position: OWNER
Credential: LCPC
Phone: 202-656-3734