Healthcare Provider Details

I. General information

NPI: 1528764453
Provider Name (Legal Business Name): PRUDENT BEHAVIORAL AND WELLNESS HEALTH LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/02/2023
Last Update Date: 02/02/2023
Certification Date: 02/02/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2107 BELFRY LN
BOWIE MD
20721-2253
US

IV. Provider business mailing address

2107 BELFRY LN
BOWIE MD
20721-2253
US

V. Phone/Fax

Practice location:
  • Phone: 240-203-6421
  • Fax:
Mailing address:
  • Phone: 240-203-6421
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QM0801X
TaxonomyMental Health Clinic/Center (Including Community Mental Health Center)
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License Number
License Number State

VIII. Authorized Official

Name: NGOZI AMADI-OBI
Title or Position: PRESIDENT
Credential: CRNP-PMH
Phone: 240-643-5638