Provider Demographics
NPI:1497451553
Name:EXOUSIA BEHAVIORAL HEALTH, LLC
Entity Type:Organization
Organization Name:EXOUSIA BEHAVIORAL HEALTH, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CLINICAL DIRECTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:OLUWAKEMI
Authorized Official - Middle Name:
Authorized Official - Last Name:AJE
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:571-409-1517
Mailing Address - Street 1:5625 ALLENTOWN RD SUITE 106
Mailing Address - Street 2:
Mailing Address - City:SUITLAND
Mailing Address - State:MD
Mailing Address - Zip Code:20746-4521
Mailing Address - Country:US
Mailing Address - Phone:571-409-1517
Mailing Address - Fax:240-301-2794
Practice Address - Street 1:5625 ALLENTOWN RD
Practice Address - Street 2:
Practice Address - City:SUITLAND
Practice Address - State:MD
Practice Address - Zip Code:20746-4521
Practice Address - Country:US
Practice Address - Phone:571-409-1517
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-01-31
Last Update Date:2023-09-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatryGroup - Multi-Specialty
No261QM0801XAmbulatory Health Care FacilitiesClinic/CenterMental Health (Including Community Mental Health Center)Group - Multi-Specialty