Healthcare Provider Details

I. General information

NPI: 1265110084
Provider Name (Legal Business Name): DIVINE WELLNESS AND PSYCHIATRIC SERVICES
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/11/2023
Last Update Date: 06/17/2026
Certification Date: 06/17/2026
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

9220 SEWALL AVE
LAUREL MD
20723-1889
US

V. Phone/Fax

Practice location:
  • Phone: 301-665-0662
  • Fax: 949-695-3269
Mailing address:
  • Phone: 240-423-1872
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QM1300X
TaxonomyMulti-Specialty Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: OLADOYIN ADEKOLA
Title or Position: PRESIDENT
Credential: CRNP-PMH
Phone: 240-423-1872