Provider Demographics
NPI:1609667443
Name:DEMAVIE BEHAVIORAL AND MENTAL WELLNESS SERVICES, INC.
Entity type:Organization
Organization Name:DEMAVIE BEHAVIORAL AND MENTAL WELLNESS SERVICES, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PROVIDER
Authorized Official - Prefix:
Authorized Official - First Name:EKUA
Authorized Official - Middle Name:AMOKWANOA
Authorized Official - Last Name:BAIDEN SOKOYA
Authorized Official - Suffix:
Authorized Official - Credentials:DNP, FNP, PMHNP-BC
Authorized Official - Phone:703-896-6603
Mailing Address - Street 1:3870 LA SIERRA AVE # 2033
Mailing Address - Street 2:
Mailing Address - City:RIVERSIDE
Mailing Address - State:CA
Mailing Address - Zip Code:92505-3528
Mailing Address - Country:US
Mailing Address - Phone:833-667-0006
Mailing Address - Fax:
Practice Address - Street 1:3972 BARBURY PALMS WAY
Practice Address - Street 2:
Practice Address - City:PERRIS
Practice Address - State:CA
Practice Address - Zip Code:92571-7473
Practice Address - Country:US
Practice Address - Phone:703-896-6603
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2025-05-13
Last Update Date:2025-05-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental HealthGroup - Multi-Specialty
No363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamilyGroup - Multi-Specialty