Provider Demographics
NPI:1396587226
Name:AMICABLE BEHAVIORAL HEALTH LLC
Entity type:Organization
Organization Name:AMICABLE BEHAVIORAL HEALTH LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PMHNP-NP
Authorized Official - Prefix:
Authorized Official - First Name:AMAECHI
Authorized Official - Middle Name:IMELDA
Authorized Official - Last Name:OLUMBA
Authorized Official - Suffix:
Authorized Official - Credentials:NURSE PRACTITIONER
Authorized Official - Phone:202-403-9934
Mailing Address - Street 1:12311 GUINEVERE RD
Mailing Address - Street 2:
Mailing Address - City:GLENN DALE
Mailing Address - State:MD
Mailing Address - Zip Code:20769-8939
Mailing Address - Country:US
Mailing Address - Phone:202-403-9934
Mailing Address - Fax:
Practice Address - Street 1:7310 GOVERNOR RITCHIE HWY STE 200-GB26
Practice Address - Street 2:
Practice Address - City:GLEN BURNIE
Practice Address - State:MD
Practice Address - Zip Code:21061-3065
Practice Address - Country:US
Practice Address - Phone:202-403-9934
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-06-11
Last Update Date:2024-09-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental HealthGroup - Single Specialty