Organization
SUPREME MENTAL WELLNESS LIMITED LIABILITY COMPANY
Active
Organization subpart
No
Provider details
NPI number
Authorized official
OLAKUNLE AYANWALE (PRESIDENT)
(240) 486-1560
Entity
Organization
Contact information
Practice address
8222 SCHULTZ RD STE 102, CLINTON, MD 20735-2607
(240) 486-1560
Mailing address
8222 SCHULTZ RD STE 102, CLINTON, MD 20735-2607
(240) 486-1560
Taxonomy
Speciality
Code
Description
License number
State
261QM0801X
Mental Health Clinic/Center (Including Community Mental Health Center)
Primary
—
—
363LP0808X
Psychiatric/Mental Health Nurse Practitioner
—
—
Other
Enumeration date
08/22/2024
Last updated
08/22/2024
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