Organization
DIVINE TOUCH THERAPEUTIC COUNSELING AND MENTORING SERVICES , LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MRS. BOLADALE WURAOLA ADEGOROYE LCPC (CLINICAL DIRECTOR)
(240) 481-9962
Entity
Organization
Contact information
Practice address
107 MOUNTAIN RD STE D, PASADENA, MD 21122-7159
(240) 481-9962
Mailing address
107 MOUNTAIN RD STE D, PASADENA, MD 21122-7159
Taxonomy
Speciality
Code
Description
License number
State
261QM0801X
Mental Health Clinic/Center (Including Community Mental Health Center)
Primary
—
—
261QM0850X
Adult Mental Health Clinic/Center
—
—
261QM0855X
Adolescent and Children Mental Health Clinic/Center
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1155938
—
MD
Enumeration date
10/23/2017
Last updated
10/23/2017
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