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General NPI Number Information
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NPI Number | 1730066416
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Entity Type | Organization
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Legal Business Name | PEACEFUL HEALING THERAPEUTIC SERVICES LLC
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Dates
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Enumeration Date | 08/16/2025
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Last Update Date | 12/21/2025
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Provider Practice Location Address
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Address Line | 12530 FAIRWOOD PKWY
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City | BOWIE
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State | MD
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Zip | 20720-6356
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Country | US
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Telephone | 202-656-3734
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Fax |
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Provider Business Mailing Address
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Address Line | 12530 FAIRWOOD PKWY STE 102 #1147
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City | BOWIE
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State | MD
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Zip | 20720-6357
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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
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Name | BRONTE' VAUGHN
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Credential | LCPC
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Telephone | 202-656-3734
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 251S00000X
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Taxonomy Name | Community/Behavioral Health Agency
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License Number |
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License Number State |
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