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General NPI Number Information
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NPI Number | 1629850979
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Entity Type | Organization
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Legal Business Name | GLADSTREAMS MENTAL HEALTH & WELLNESS ,LLC
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Dates
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Enumeration Date | 10/19/2023
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Last Update Date | 10/19/2023
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Provider Practice Location Address
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Address Line | 4500 FORBES BLVD STE 200
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City | LANHAM
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State | MD
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Zip | 20706-6316
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Country | US
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Telephone | 202-203-9567
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Fax |
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Provider Business Mailing Address
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Address Line | 4500 FORBES BLVD STE 200
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City | LANHAM
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State | MD
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Zip | 20706-6316
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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 | NURSE PRACTITIONER
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Name | OLAYINKA SOGBOLA
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Credential |
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Telephone | 202-203-9567
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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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