Provider Demographics
NPI:1780447102
Name:PROFICIENT MIND AND WELLNESS CLINIC LLC
Entity type:Organization
Organization Name:PROFICIENT MIND AND WELLNESS CLINIC LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:NURSE PRACTITIONER
Authorized Official - Prefix:MRS
Authorized Official - First Name:OLATOKUNBO
Authorized Official - Middle Name:
Authorized Official - Last Name:GBADEBO
Authorized Official - Suffix:
Authorized Official - Credentials:FNP-BC, PMHNP-BC
Authorized Official - Phone:302-467-2646
Mailing Address - Street 1:665 S CARTER RD UNIT 2
Mailing Address - Street 2:
Mailing Address - City:SMYRNA
Mailing Address - State:DE
Mailing Address - Zip Code:19977-7728
Mailing Address - Country:US
Mailing Address - Phone:302-674-2646
Mailing Address - Fax:302-467-2857
Practice Address - Street 1:665 S CARTER RD
Practice Address - Street 2:
Practice Address - City:SMYRNA
Practice Address - State:DE
Practice Address - Zip Code:19977-7728
Practice Address - Country:US
Practice Address - Phone:302-467-2646
Practice Address - Fax:302-467-2857
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-01-31
Last Update Date:2024-03-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QH0100XAmbulatory Health Care FacilitiesClinic/CenterHealth Service
No261Q00000XAmbulatory Health Care FacilitiesClinic/Center
No261QM0801XAmbulatory Health Care FacilitiesClinic/CenterMental Health (Including Community Mental Health Center)