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Organization
DIVINE HEALTH MEDICAL AND SPA LLC
Active
Organization
DIVINE HEALTH MEDICAL AND SPA LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
SALLY OWIE YOUNG FNP (EDUCATOR)
(240) 437-9997
Entity
Organization
Contact information
Practice address
11119 ROCKVILLE PIKE STE 320, ROCKVILLE, MD 20852-3143
(240) 669-6598
(240) 669-6079
Mailing address
12406 BUCKLEY DR, SILVER SPRING, MD 20904-2017
(240) 437-9997
(240) 669-6079
Taxonomy
Speciality
Code
Description
License number
State
261QP2300X
Primary Care Clinic/Center
Primary
—
—
363LF0000X
Family Nurse Practitioner
—
—
Other
Enumeration date
04/19/2022
Last updated
07/14/2022
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