Healthcare Provider Details

I. General information

NPI: 1336974591
Provider Name (Legal Business Name): GRACE MENTAL WELLNESS LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/05/2024
Last Update Date: 02/25/2025
Certification Date: 02/25/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10770 COLUMBIA PIKE STE 300
SILVER SPRING MD
20901-4439
US

IV. Provider business mailing address

10770 COLUMBIA PIKE STE 300
SILVER SPRING MD
20901-4439
US

V. Phone/Fax

Practice location:
  • Phone: 240-863-2777
  • Fax:
Mailing address:
  • Phone:
  • 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: GRACE OLALEYE-ANISERE
Title or Position: PMHNP-BC
Credential: DNP
Phone: 210-413-1103