Healthcare Provider Details

I. General information

NPI: 1134907249
Provider Name (Legal Business Name): EMAEL MENTAL HEALTH SERVICES
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/19/2023
Last Update Date: 04/07/2026
Certification Date: 04/07/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4762 CAMBRIA RD
FREDERICK MD
21703-2909
US

IV. Provider business mailing address

324 VALE ST
HAGERSTOWN MD
21740-4149
US

V. Phone/Fax

Practice location:
  • Phone: 301-835-2788
  • Fax: 800-507-2396
Mailing address:
  • Phone: 301-835-2788
  • Fax: 800-507-2396

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: ELIONORE M NKWEMOU
Title or Position: CEO
Credential:
Phone: 301-835-2788