Healthcare Provider Details

I. General information

NPI: 1083441364
Provider Name (Legal Business Name): GOLDEN WARMTH BEHAVIORAL HEALTH
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/19/2024
Last Update Date: 09/19/2024
Certification Date: 09/19/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

12412 DORSEY LN
UPPER MARLBORO MD
20772-5372
US

IV. Provider business mailing address

12412 DORSEY LN
UPPER MARLBORO MD
20772-5372
US

V. Phone/Fax

Practice location:
  • Phone: 202-413-6929
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QM0850X
TaxonomyAdult Mental Health Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: CLEMENTINE OKIE
Title or Position: PMHNP
Credential: PMHNP
Phone: 202-413-6929