Healthcare Provider Details

I. General information

NPI: 1295342772
Provider Name (Legal Business Name): GILEAD ASSOCIATES LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/28/2020
Last Update Date: 09/08/2023
Certification Date: 09/07/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7661 ARUNDEL MILLS BLVD
HANOVER MD
21076-1305
US

IV. Provider business mailing address

206 MULBERRY RIDGE CT
PASADENA MD
21122-7514
US

V. Phone/Fax

Practice location:
  • Phone: 672-250-6736
  • Fax:
Mailing address:
  • Phone: 432-038-0944
  • Fax:

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 Code363L00000X
TaxonomyNurse Practitioner
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License Number
License Number State

VIII. Authorized Official

Name: GBEMISOLA ELIZABETH MOJELOPE
Title or Position: CLINICAL DIRECTOR
Credential: PMHNP-BC
Phone: 667-225-0673