Healthcare Provider Details

I. General information

NPI: 1427983865
Provider Name (Legal Business Name): DEMAR BEHAVIORAL HEALTH AND WELLNESS CLINIC LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/16/2026
Last Update Date: 06/18/2026
Certification Date: 06/18/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7375 EXECUTIVE PL STE 200
LANHAM MD
20706-6234
US

IV. Provider business mailing address

7375 EXECUTIVE PL STE 200
LANHAM MD
20706-6234
US

V. Phone/Fax

Practice location:
  • Phone: 202-940-2022
  • Fax:
Mailing address:
  • Phone: 202-940-2022
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License Number
License Number State

VIII. Authorized Official

Name: MARITA ATEHAKOH FORMIN
Title or Position: OWNER
Credential:
Phone: 202-940-2022