Healthcare Provider Details

I. General information

NPI: 1861302028
Provider Name (Legal Business Name): ALTITUDE BEHAVIORAL CARE LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/10/2026
Last Update Date: 09/10/2026
Certification Date: 09/10/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7700 OLD BRANCH AVE STE C104
CLINTON MD
20735-1628
US

IV. Provider business mailing address

8508 TOPAZ CT
CLINTON MD
20735-3342
US

V. Phone/Fax

Practice location:
  • Phone: 240-348-2444
  • Fax: 240-348-2454
Mailing address:
  • Phone:
  • Fax:

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: OLUWASINA A OGUNTOMI
Title or Position: OWNER
Credential:
Phone: 240-348-2444