Provider Demographics
NPI:1669158788
Name:CHELLE & KAMBRIDGE MENTAL HEALTH SERVICES LLC
Entity type:Organization
Organization Name:CHELLE & KAMBRIDGE MENTAL HEALTH SERVICES LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:ODUNOLA
Authorized Official - Middle Name:
Authorized Official - Last Name:ADEYEYE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:202-344-5709
Mailing Address - Street 1:PO BOX 473
Mailing Address - Street 2:
Mailing Address - City:LINTHICUM HEIGHTS
Mailing Address - State:MD
Mailing Address - Zip Code:21090-0473
Mailing Address - Country:US
Mailing Address - Phone:202-344-5709
Mailing Address - Fax:
Practice Address - Street 1:515 S CAMP MEADE RD
Practice Address - Street 2:
Practice Address - City:LINTHICUM HEIGHTS
Practice Address - State:MD
Practice Address - Zip Code:21090-7500
Practice Address - Country:US
Practice Address - Phone:202-838-7211
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-06-23
Last Update Date:2024-10-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental HealthGroup - Single Specialty