# INTEGRATED MEDICAL CLINIC

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

## Provider details

- **NPI number:** 1811578347
- **Authorized official:** OLIVIA NGUH (OWNER)
- **Authorized official phone:** (410) 521-8000

## Contact information

- **Practice address:** 7404 EXECUTIVE PL STE 100, LANHAM, MD 20706-6237
- **Practice address phone:** (240) 758-1782
- **Mailing address:** 7404 EXECUTIVE PL STE 100, LANHAM, MD 20706-6237
- **Mailing address phone:** (240) 260-3827
- **Mailing address fax:** (240) 260-3830

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 261QM0801X | Mental Health Clinic/Center (Including Community Mental Health Center) | — | NULL | — |
| 261QM0850X | Adult Mental Health Clinic/Center | — | NULL | — |
| 363LP0808X | Psychiatric/Mental Health Nurse Practitioner | — | NULL | Yes |
| 363LP0808X | Psychiatric/Mental Health Nurse Practitioner | — | — | Yes |

## Other

- **Enumeration date:** 04/16/2021
- **Last updated:** 01/10/2024