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General NPI Number Information
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NPI Number | 1346126216
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Entity Type | Organization
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Legal Business Name | SHEPHERDS PATH MENTAL WELLNESS
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Dates
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Enumeration Date | 08/14/2025
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Last Update Date | 08/14/2025
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Provider Practice Location Address
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Address Line | 702 TURKANA CIR
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City | ABERDEEN
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State | MD
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Zip | 21001-1266
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Country | US
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Telephone | 667-567-0110
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Fax | 667-280-4044
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Provider Business Mailing Address
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Address Line | 702 TURKANA CIR
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City | ABERDEEN
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State | MD
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Zip | 21001-1266
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Country | US
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Telephone | 443-449-9019
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Fax |
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Authorized Official
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Title or Position | CEO
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Name | BOLANLE C THANI
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Credential |
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Telephone | 443-449-9019
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QM0801X
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Taxonomy Name | Mental Health Clinic/Center (Including Community Mental Health Center)
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License Number |
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License Number State |
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Taxonomy #2
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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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