MEDICARE: DIVINE CHARIS HEALTH SERVICES LLC

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
1	261QM0801X	Mental Health Clinic/Center (Including Community Mental Health Center)

General Provider Information

NPI Number	:	1548113111
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	DIVINE CHARIS HEALTH SERVICES LLC

Provider Business Mailing Address
First Line	:	11005 FILLYS FORD XING
Second Line	:
City	:	UPPER MARLBORO
State	:	MD
Zip	:	20772-8314
Country	:	US
Telephone Number	:	202-352-4059
Fax Number	:

Provider Business Practice Location Address
First Line	:	11005 FILLYS FORD XING
Second Line	:
City	:	UPPER MARLBORO
State	:	MD
Zip	:	20772-8314
Country	:	US
Telephone Number	:	202-352-4059
Fax Number	:

Authorized Official
Title or Position	:	OWNER
Name	:	ABONG MIYEH
Credential	:
Telephone Number	:	202-352-4059

Provider Enumeration Date	:	02/16/2026
Last Update Date	:	06/05/2026

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