Healthcare Provider Details

I. General information

NPI: 1154094548
Provider Name (Legal Business Name): HIS &HER MEDICAL AND MENTAL HEALTH SERVICES
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/30/2021
Last Update Date: 07/31/2026
Certification Date: 07/31/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9015 WOODYARD RD STE 111B
CLINTON MD
20735-4209
US

IV. Provider business mailing address

9015 WOODYARD RD STE 111B
CLINTON MD
20735-4209
US

V. Phone/Fax

Practice location:
  • Phone: 240-493-7847
  • Fax: 240-493-7327
Mailing address:
  • Phone: 240-493-7847
  • Fax: 240-493-7327

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: EFEMWONYI F JESUOROBO
Title or Position: OWNER OF ENTITY
Credential: DNP, CRNP, FNP,PMHNP
Phone: 240-493-7847