Healthcare Provider Details

I. General information

NPI: 1811727233
Provider Name (Legal Business Name): GLADELL MENTAL WELLNESS LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/02/2024
Last Update Date: 03/13/2026
Certification Date: 03/13/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2512 GALESHEAD DR
UPPER MARLBORO MD
20774-8012
US

IV. Provider business mailing address

2512 GALESHEAD DR
UPPER MARLBORO MD
20774-8012
US

V. Phone/Fax

Practice location:
  • Phone: 202-421-5994
  • Fax:
Mailing address:
  • Phone: 202-421-5994
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QM0801X
TaxonomyMental Health Clinic/Center (Including Community Mental Health Center)
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License Number
License Number State

VIII. Authorized Official

Name: DR. GLADYS AGIRIGA ANOKAM
Title or Position: PROVIDER
Credential: DNP,CRNP-PMHNP-BC,RN
Phone: 202-421-5994