Organization
DIVINE HEALTH PSYCHIATRIC SERVICES LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
EMMANUEL GBALA (PRESIDENT)
(443) 204-3919
Entity
Organization
Contact information
Practice address
117 E CHERRY HILL RD, REISTERSTOWN, MD 21136-3023
(443) 204-3919
(410) 521-3671
Mailing address
117 E CHERRY HILL RD, REISTERSTOWN, MD 21136-3023
(443) 204-3919
(410) 521-3671
Taxonomy
Speciality
Code
Description
License number
State
261QM1300X
Multi-Specialty Clinic/Center
Primary
—
—
Other
Enumeration date
07/21/2023
Last updated
07/21/2023
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