Healthcare Provider Details

I. General information

NPI: 1144701772
Provider Name (Legal Business Name): HEFUNA MENTAL HEALTH WELLNESS LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/22/2018
Last Update Date: 08/22/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3416 OLANDWOOD CT STE 201
OLNEY MD
20832-1373
US

IV. Provider business mailing address

7474 GREENWAY CENTER DR
GREENBELT MD
20770-3504
US

V. Phone/Fax

Practice location:
  • Phone: 301-969-4060
  • Fax:
Mailing address:
  • Phone: 301-982-3437
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License Number
License Number State

VIII. Authorized Official

Name: CAROLYN REIDY
Title or Position: MANAGER
Credential:
Phone: 845-590-3230