Provider Demographics
NPI:1598549040
Name:WILLIAM-MICAH PSYCHIATRIC SERVICES LLC
Entity Type:Organization
Organization Name:WILLIAM-MICAH PSYCHIATRIC SERVICES LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PMHNP/OWNER
Authorized Official - Prefix:
Authorized Official - First Name:FRANCIS
Authorized Official - Middle Name:IFEANYI
Authorized Official - Last Name:IHEJIRIKA
Authorized Official - Suffix:
Authorized Official - Credentials:NP
Authorized Official - Phone:301-412-1594
Mailing Address - Street 1:6811 KENILWORTH AVE STE 500-E12
Mailing Address - Street 2:
Mailing Address - City:RIVERDALE
Mailing Address - State:MD
Mailing Address - Zip Code:20737-1333
Mailing Address - Country:US
Mailing Address - Phone:301-412-1594
Mailing Address - Fax:
Practice Address - Street 1:6811 KENILWORTH AVE STE 500-E12
Practice Address - Street 2:
Practice Address - City:RIVERDALE
Practice Address - State:MD
Practice Address - Zip Code:20737-1333
Practice Address - Country:US
Practice Address - Phone:301-412-1594
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-08-23
Last Update Date:2023-10-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental HealthGroup - Single Specialty