# LEADETH STILLWATERS

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- **Entity:** Organization
- **Status:** Active
- **Organization subpart:** No

## Provider details

- **NPI number:** 1497467641
- **Authorized official:** FATIMA MUNA KOROMA NP (CEO)
- **Authorized official phone:** (571) 277-1111

## Contact information

- **Practice address:** 712 H ST NE STE 1628, WASHINGTON, DC 20002-3627
- **Practice address phone:** (301) 265-5922
- **Mailing address:** 9461 CHARLEVILLE BLVD STE 1216, BEVERLY HILLS, CA 90212-3017
- **Mailing address phone:** (301) 265-5922
- **Mailing address fax:** (475) 275-7541

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 363LP0808X | Psychiatric/Mental Health Nurse Practitioner | — | NULL | Yes |
| 363LP0808X | Psychiatric/Mental Health Nurse Practitioner | — | — | Yes |

## Other

- **Enumeration date:** 12/20/2022
- **Last updated:** 06/05/2026