Healthcare Provider Details

I. General information

NPI: 1760316103
Provider Name (Legal Business Name): SOLACE ELITE PSYCHIATRY LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/10/2026
Last Update Date: 06/10/2026
Certification Date: 06/10/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4500 FORBES BLVD STE W1
LANHAM MD
20706-6312
US

IV. Provider business mailing address

8507 OXON HILL RD. STE 200 #1189
FORT WASHINGTON MD
20744
US

V. Phone/Fax

Practice location:
  • Phone: 240-229-6741
  • Fax:
Mailing address:
  • Phone: 240-229-6741
  • 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

VIII. Authorized Official

Name: TA'KISHA TERRELL
Title or Position: PMHNP-BC/CEO
Credential: CRNP
Phone: 240-229-6741