Provider Demographics
NPI:1093469231
Name:MJB HOLISTIC AND THERAPEUTIC SERVICES
Entity Type:Organization
Organization Name:MJB HOLISTIC AND THERAPEUTIC SERVICES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO/NURSE PRACTITIONER
Authorized Official - Prefix:MRS
Authorized Official - First Name:MELVEENA
Authorized Official - Middle Name:
Authorized Official - Last Name:JOHNSON-BOLDEN
Authorized Official - Suffix:
Authorized Official - Credentials:PMHNP-BC
Authorized Official - Phone:240-301-1034
Mailing Address - Street 1:1300 MERCANTILE LN STE 129-14
Mailing Address - Street 2:
Mailing Address - City:UPPER MARLBORO
Mailing Address - State:MD
Mailing Address - Zip Code:20774-5327
Mailing Address - Country:US
Mailing Address - Phone:301-381-3622
Mailing Address - Fax:
Practice Address - Street 1:1300 MERCANTILE LN STE 129-14
Practice Address - Street 2:
Practice Address - City:UPPER MARLBORO
Practice Address - State:MD
Practice Address - Zip Code:20774-5327
Practice Address - Country:US
Practice Address - Phone:301-381-3622
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-02-07
Last Update Date:2023-05-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health
No261QC1500XAmbulatory Health Care FacilitiesClinic/CenterCommunity Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
MDB435599428868OtherDRIVERS LIC