Healthcare Provider Details

I. General information

NPI: 1154861383
Provider Name (Legal Business Name): DIVERSITY BEHAVIORAL HEALTH SERVICES
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/07/2017
Last Update Date: 03/07/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9470 ANNAPOLIS RD SUITE411
LANHAM MD
20706-3025
US

IV. Provider business mailing address

9470 ANNAPOLIS RD SUITE 411
LANHAM MD
20706-3025
US

V. Phone/Fax

Practice location:
  • Phone: 443-845-0452
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code302F00000X
TaxonomyExclusive Provider Organization
License Number
License Number State

VIII. Authorized Official

Name: MR. ALEX IKE OKEKE
Title or Position: DIRECTOR
Credential:
Phone: 443-845-0452