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DIVINE TOUCH THERAPEUTIC COUNSELING AND MENTORING SERVICES , LLC

Ambulatory Health Care Facilities Clinic/Center Adult Mental Health

Provider NPI: 1386155968

Organization Information:
Organization Name:  DIVINE TOUCH THERAPEUTIC COUNSELING AND MENTORING SERVICES , LLC
Organization is not Subpart
Authorized Official:  BOLADALE WURAOLA ADEGOROYE  CLINICAL DIRECTOR  240-481-9962

Practice Location:
107 MOUNTAIN RD STE D  PASADENA, MD 21122-7159 US
Tel: 240-481-9962  Fax: --

Business Mailing Address:
107 MOUNTAIN RD STE D  PASADENA, MD 21122-7159 US
Tel: --  Fax: --

NPI Information:
NPI: 1386155968
Entity Type: Organization

Taxonomy:

PrimaryCodeCategory/DescriptionStateLicense Number
N261QM0850XAmbulatory Health Care Facilities
Clinic/Center
Adult Mental Health
N261QM0855XAmbulatory Health Care Facilities
Clinic/Center
Y261QM0801XAmbulatory Health Care Facilities
Clinic/Center

Other Provider Identifiers:

IssuerNumberStateType
1155938MD05



American Medical Association 2012 taxonomy code information

Code: 261QM0801X

Type:

Classification:



Definition:



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