Healthcare Provider Details

I. General information

NPI: 1013692367
Provider Name (Legal Business Name): CITADEL BEHAVIORAL HEALTHCARE CONSULTING LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/15/2023
Last Update Date: 08/19/2026
Certification Date: 08/19/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6492 LANDOVER RD STE B3
CHEVERLY MD
20785-1400
US

IV. Provider business mailing address

9814 PASSAGE DR
UPPER MARLBORO MD
20772-4544
US

V. Phone/Fax

Practice location:
  • Phone: 240-988-3779
  • Fax:
Mailing address:
  • Phone: 240-988-3779
  • Fax: 270-254-8484

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License Number
License Number State

VIII. Authorized Official

Name: MUTIAT POPOOLA
Title or Position: AUTHORIZED OFFICIAL/OWNER
Credential: NP
Phone: 240-988-3779