Provider Demographics
NPI:1497440820
Name:SOLACE MENTAL HEALTHCARE LLC
Entity Type:Organization
Organization Name:SOLACE MENTAL HEALTHCARE LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:UGO
Authorized Official - Middle Name:O
Authorized Official - Last Name:AZUEWAH
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:240-602-6005
Mailing Address - Street 1:1314 IRON OAK CV
Mailing Address - Street 2:
Mailing Address - City:CROFTON
Mailing Address - State:MD
Mailing Address - Zip Code:21114-1868
Mailing Address - Country:US
Mailing Address - Phone:240-602-6005
Mailing Address - Fax:
Practice Address - Street 1:9500 ANNAPOLIS RD
Practice Address - Street 2:
Practice Address - City:LANHAM
Practice Address - State:MD
Practice Address - Zip Code:20706-2060
Practice Address - Country:US
Practice Address - Phone:240-602-6005
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-04-11
Last Update Date:2023-04-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental HealthGroup - Multi-Specialty