Healthcare Provider Details

I. General information

NPI: 1508564683
Provider Name (Legal Business Name): SOLACE MENTAL HEALTHCARE, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/20/2023
Last Update Date: 02/20/2023
Certification Date: 02/18/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9500 ANNAPOLIS RD
LANHAM MD
20706-2060
US

IV. Provider business mailing address

1314 IRON OAK CV
CROFTON MD
21114-1868
US

V. Phone/Fax

Practice location:
  • Phone: 240-602-6005
  • Fax:
Mailing address:
  • Phone: 240-602-6005
  • 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: UGO AZUEWAH
Title or Position: PROVIDER
Credential: PMHNP
Phone: 240-602-6005