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General NPI Number Information
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NPI Number | 1265283899
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Entity Type | Organization
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Legal Business Name | SYNCHRONY BEHAVIORAL HEALTH SERVICES LLC
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Dates
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Enumeration Date | 04/01/2024
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Last Update Date | 12/16/2024
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Provider Practice Location Address
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Address Line | 2 INDUSTRIAL PARK DR STE D
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City | WALDORF
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State | MD
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Zip | 20602-2729
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Country | US
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Telephone | 667-382-8624
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Fax |
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Provider Business Mailing Address
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Address Line | 2925 WINTERBOURNE DR
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City | UPPER MARLBORO
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State | MD
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Zip | 20774-9103
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | OWNER/CEO
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Name | DORIS OGUNMAKINWA
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Credential |
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Telephone | 667-382-8624
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363LP0808X
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Taxonomy Name | Psychiatric/Mental Health Nurse Practitioner
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License Number |
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License Number State |
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