Provider Demographics
NPI:1801573605
Name:AUTHENTIC MENTAL WELLNESS LLC
Entity type:Organization
Organization Name:AUTHENTIC MENTAL WELLNESS LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PROVIDER
Authorized Official - Prefix:
Authorized Official - First Name:FRANCINE
Authorized Official - Middle Name:
Authorized Official - Last Name:KAMHOUA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:703-508-6182
Mailing Address - Street 1:10810 DARNESTOWN RD STE 103
Mailing Address - Street 2:
Mailing Address - City:GAITHERSBURG
Mailing Address - State:MD
Mailing Address - Zip Code:20878-2604
Mailing Address - Country:US
Mailing Address - Phone:240-829-1863
Mailing Address - Fax:240-238-6187
Practice Address - Street 1:10810 DARNESTOWN RD STE 103
Practice Address - Street 2:
Practice Address - City:GAITHERSBURG
Practice Address - State:MD
Practice Address - Zip Code:20878-2604
Practice Address - Country:US
Practice Address - Phone:240-829-1863
Practice Address - Fax:240-238-6187
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-07-03
Last Update Date:2024-11-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental HealthGroup - Multi-Specialty
No261QM0801XAmbulatory Health Care FacilitiesClinic/CenterMental Health (Including Community Mental Health Center)