Healthcare Provider Details

I. General information

NPI: 1487598090
Provider Name (Legal Business Name): SKOTS GROUP LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/15/2026
Last Update Date: 04/15/2026
Certification Date: 04/15/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

408 RIDGE RD APT 11
GREENBELT MD
20770-1629
US

IV. Provider business mailing address

408 RIDGE RD APT 11
GREENBELT MD
20770-1629
US

V. Phone/Fax

Practice location:
  • Phone: 240-547-7015
  • Fax:
Mailing address:
  • Phone: 240-547-7015
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2084A0401X
TaxonomyAddiction Medicine (Psychiatry & Neurology) Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code2084P0802X
TaxonomyAddiction Psychiatry Physician
License Number
License Number State
# 4
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number State

VIII. Authorized Official

Name: MRS. SIMSOLA IPAYE
Title or Position: PROGRAM DIRECTOR
Credential:
Phone: 240-547-7015