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General NPI Number Information
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NPI Number | 1871368381
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Entity Type | Organization
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Legal Business Name | D-LAITE GROUP LLC
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Dates
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Enumeration Date | 11/15/2023
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Last Update Date | 11/15/2023
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Provider Practice Location Address
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Address Line | 2901 DRUID PARK DR STE A202
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City | BALTIMORE
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State | MD
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Zip | 21215-8131
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Country | US
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Telephone | 443-449-1908
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Fax |
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Provider Business Mailing Address
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Address Line | 3717 WOLF TRAIL DR
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City | ABINGDON
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State | MD
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Zip | 21009-4306
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Country | US
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Telephone | 443-449-1908
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Fax |
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Authorized Official
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Title or Position | CEO
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Name | KEHINDE JOSEPH
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Credential | NP
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Telephone | 443-449-1908
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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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