Healthcare Provider Details

I. General information

NPI: 1144183047
Provider Name (Legal Business Name): CAREVINA BEHAVIORAL HEALTH LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/08/2025
Last Update Date: 12/08/2025
Certification Date: 12/07/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

46940 S SHANGRI LA DR STE 100-13
LEXINGTON PARK MD
20653-1037
US

IV. Provider business mailing address

46940 S SHANGRI LA DR STE 100-13
LEXINGTON PARK MD
20653-1037
US

V. Phone/Fax

Practice location:
  • Phone: 240-510-4216
  • Fax:
Mailing address:
  • Phone: 240-510-4216
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number State

VIII. Authorized Official

Name: ADEBOLA AYANDA-WILSON
Title or Position: MD
Credential:
Phone: 240-510-4216