Healthcare Provider Details
I. General information
NPI: 1780552216
Provider Name (Legal Business Name): PENUEL BEHAVIORAL HEALTH SERVICES LLC.
Entity Type: Organization
Gender:
Sole Proprietor:
II. Dates (important events)
Enumeration Date: 10/27/2025
Last Update Date: 03/25/2026
Certification Date: 03/25/2026
Deactivation Date:
Reactivation Date:
III. Provider practice location address
3140 W WARD RD STE 201
DUNKIRK MD
20754-3047
US
IV. Provider business mailing address
3140 W WARD RD STE 201
DUNKIRK MD
20754-3047
US
V. Phone/Fax
- Phone: 301-635-1240
- Fax:
- Phone:
- Fax:
VI. Provider taxonomy
Scope of Practice (Provider specialty)
| # 1 | |
| Primary Taxonomy | N |
| Taxonomy Code | 101YM0800X |
| Taxonomy | Mental Health Counselor |
| License Number | |
| License Number State | |
| # 2 | |
| Primary Taxonomy | N |
| Taxonomy Code | 103TB0200X |
| Taxonomy | Cognitive & Behavioral Psychologist |
| License Number | |
| License Number State | |
| # 3 | |
| Primary Taxonomy | Y |
| Taxonomy Code | 103TR0400X |
| Taxonomy | Rehabilitation Psychologist |
| License Number | |
| License Number State | |
VIII. Authorized Official
Name:
OLABIMPE
OLOJO
Title or Position: OWNER
Credential:
Phone: 301-832-7666