Provider Demographics
NPI:1265110084
Name:DIVINE WELLNESS AND PSYCHIATRIC SERVICES
Entity type:Organization
Organization Name:DIVINE WELLNESS AND PSYCHIATRIC SERVICES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:OLADOYIN
Authorized Official - Middle Name:
Authorized Official - Last Name:ADEKOLA
Authorized Official - Suffix:
Authorized Official - Credentials:CRNP-PMH
Authorized Official - Phone:240-423-1872
Mailing Address - Street 1:9220 SEWALL AVE
Mailing Address - Street 2:
Mailing Address - City:LAUREL
Mailing Address - State:MD
Mailing Address - Zip Code:20723-1889
Mailing Address - Country:US
Mailing Address - Phone:240-423-1872
Mailing Address - Fax:
Practice Address - Street 1:9220 SEWALL AVE
Practice Address - Street 2:
Practice Address - City:LAUREL
Practice Address - State:MD
Practice Address - Zip Code:20723-1889
Practice Address - Country:US
Practice Address - Phone:301-665-0662
Practice Address - Fax:443-535-1784
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-07-11
Last Update Date:2023-07-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM1300XAmbulatory Health Care FacilitiesClinic/CenterMulti-Specialty