# ELITE MULTI SPECIALTY CLINIC, LLC

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- **Entity:** Organization
- **Status:** Active
- **Other names:** Elite Multi Specialty Clinic, LLC
- **Organization subpart:** No

## Provider details

- **NPI number:** 1699386789
- **Authorized official:** ADAORA PERPETUA NOUMMY (OFFICE ADMIN)
- **Authorized official phone:** (301) 592-1780

## Contact information

- **Practice address:** 12501 PROSPERITY DR STE 330, SILVER SPRING, MD 20904-1655
- **Practice address phone:** (301) 592-1780
- **Practice address fax:** (240) 645-4013
- **Mailing address:** 12501 PROSPERITY DR STE 330, SILVER SPRING, MD 20904-1655
- **Mailing address phone:** (301) 592-1780
- **Mailing address fax:** (240) 645-4013

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 251S00000X | Community/Behavioral Health Agency | — | NULL | — |
| 261QM0850X | Adult Mental Health Clinic/Center | — | NULL | — |
| 261QM0855X | Adolescent and Children Mental Health Clinic/Center | — | NULL | — |
| 363LP0808X | Psychiatric/Mental Health Nurse Practitioner | — | NULL | Yes |
| 363LP0808X | Psychiatric/Mental Health Nurse Practitioner | — | — | Yes |

## Other

- **Enumeration date:** 08/12/2020
- **Last updated:** 08/12/2020