Healthcare Provider Details

I. General information

NPI: 1861304073
Provider Name (Legal Business Name): PROMISE HEALTH SERVICES LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/22/2026
Last Update Date: 09/22/2026
Certification Date: 09/22/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3220 OLD WASHINGTON RD STE 7
WALDORF MD
20602-3314
US

IV. Provider business mailing address

3220 OLD WASHINGTON RD STE 7
WALDORF MD
20602-3314
US

V. Phone/Fax

Practice location:
  • Phone: 301-751-3913
  • Fax: 301-751-3913
Mailing address:
  • Phone: 301-751-3913
  • Fax: 301-751-3913

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code251S00000X
TaxonomyCommunity/Behavioral Health Agency
License Number
License Number State
# 4
Primary TaxonomyN
Taxonomy Code261QM0801X
TaxonomyMental Health Clinic/Center (Including Community Mental Health Center)
License Number
License Number State

VIII. Authorized Official

Name: DR. ADOLF SCHWARTZ AYUKETAH
Title or Position: CEO
Credential: PHARMD
Phone: 301-751-3913