Provider Demographics
NPI:1215829072
Name:GRACIOUS PSYCHIATRIC HEALTHCARE SERVICES LLC
Entity type:Organization
Organization Name:GRACIOUS PSYCHIATRIC HEALTHCARE SERVICES LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DNP, PMHNP-BC
Authorized Official - Prefix:DR
Authorized Official - First Name:GOLDMAY
Authorized Official - Middle Name:OGBENYALU
Authorized Official - Last Name:ONUMA
Authorized Official - Suffix:
Authorized Official - Credentials:DNP
Authorized Official - Phone:301-768-7140
Mailing Address - Street 1:9334 CREEKVIEW DR
Mailing Address - Street 2:
Mailing Address - City:LAUREL
Mailing Address - State:MD
Mailing Address - Zip Code:20708-3205
Mailing Address - Country:US
Mailing Address - Phone:301-768-7140
Mailing Address - Fax:
Practice Address - Street 1:55 WADE AVE
Practice Address - Street 2:
Practice Address - City:CATONSVILLE
Practice Address - State:MD
Practice Address - Zip Code:21228-4663
Practice Address - Country:US
Practice Address - Phone:301-768-7140
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2025-07-16
Last Update Date:2025-07-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental HealthGroup - Single Specialty