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General NPI Number Information
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NPI Number | 1841037728
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Entity Type | Organization
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Legal Business Name | OMEGA BEHAVIORAL CLINIC LLC
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Dates
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Enumeration Date | 07/09/2024
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Last Update Date | 11/19/2024
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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 | 301-520-6782
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Fax |
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Provider Business Mailing Address
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Address Line | 1202 NORTHERN LIGHTS DR
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City | UPPER MARLBORO
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State | MD
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Zip | 20774-6049
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Country | US
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Telephone | 301-520-6782
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Fax |
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Authorized Official
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Title or Position | NURSE PRACTIONER
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Name | OLUFUNKE TAIWO
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Credential | CRNP
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Telephone | 301-520-6782
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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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