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NPI Code Detail

MEDICARE: DIVINE WELLNESS AND PSYCHIATRIC SERVICES

MEDICARE: DIVINE WELLNESS AND PSYCHIATRIC SERVICES
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1363LP0808XPsychiatric/Mental Health Nurse Practitioner
2261QM0801XMental Health Clinic/Center (Including Community Mental Health Center)

General Provider Information

NPI Number : 1336945443
Entity Type Code : Organization
Provider Name (Legal Business Name) : DIVINE WELLNESS AND PSYCHIATRIC SERVICES
Provider Business Mailing Address
First Line : 9220 SEWALL AVE
Second Line :
City : LAUREL
State : MD
Zip : 20723-1889
Country : US
Telephone Number : 301-665-0074
Fax Number : 301-637-1706
Provider Business Practice Location Address
First Line : 6340 SECURITY BLVD STE 100
Second Line :
City : GWYNN OAK
State : MD
Zip : 21207-5284
Country : US
Telephone Number : 301-665-0074
Fax Number : 301-637-1706
Authorized Official
Title or Position : PRESIDENT
Name : OLADOYIN OLADAYO ADEKOLA
Credential :
Telephone Number : 301-665-0662
Provider Enumeration Date : 02/20/2025
Last Update Date : 02/20/2025

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Directions to “DIVINE WELLNESS AND PSYCHIATRIC SERVICES ” Practice Location

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