Provider Demographics
NPI:1336945443
Name:DIVINE WELLNESS AND PSYCHIATRIC SERVICES
Entity type:Organization
Organization Name:DIVINE WELLNESS AND PSYCHIATRIC SERVICES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:OLADOYIN
Authorized Official - Middle Name:OLADAYO
Authorized Official - Last Name:ADEKOLA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:301-665-0662
Mailing Address - Street 1:9220 SEWALL AVE
Mailing Address - Street 2:
Mailing Address - City:LAUREL
Mailing Address - State:MD
Mailing Address - Zip Code:20723-1889
Mailing Address - Country:US
Mailing Address - Phone:301-665-0074
Mailing Address - Fax:301-637-1706
Practice Address - Street 1:6340 SECURITY BLVD STE 100
Practice Address - Street 2:
Practice Address - City:GWYNN OAK
Practice Address - State:MD
Practice Address - Zip Code:21207-5284
Practice Address - Country:US
Practice Address - Phone:301-665-0074
Practice Address - Fax:301-637-1706
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2025-02-20
Last Update Date:2025-02-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes261QM0801XAmbulatory Health Care FacilitiesClinic/CenterMental Health (Including Community Mental Health Center)
No363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental HealthGroup - Multi-Specialty