Provider Demographics
NPI:1386487643
Name:MIVA MENTAL HEALTHCARE
Entity type:Organization
Organization Name:MIVA MENTAL HEALTHCARE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:AKOUVI
Authorized Official - Middle Name:DZIGBODI
Authorized Official - Last Name:AMOUZOUVI-ABA
Authorized Official - Suffix:
Authorized Official - Credentials:NP
Authorized Official - Phone:409-356-9778
Mailing Address - Street 1:1614 NORDIC HILL CIR
Mailing Address - Street 2:
Mailing Address - City:SILVER SPRING
Mailing Address - State:MD
Mailing Address - Zip Code:20906-5927
Mailing Address - Country:US
Mailing Address - Phone:409-356-9778
Mailing Address - Fax:
Practice Address - Street 1:1614 NORDIC HILL CIR
Practice Address - Street 2:
Practice Address - City:SILVER SPRING
Practice Address - State:MD
Practice Address - Zip Code:20906-5927
Practice Address - Country:US
Practice Address - Phone:409-356-9778
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-06-14
Last Update Date:2024-09-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental HealthGroup - Single Specialty