Organization
GATEWAY BEHAVIORAL HEALTH LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
GRACE DOH PMHNP (PRESIDENT)
(240) 505-5427
Entity
Organization
Contact information
Practice address
6500 MANTON WAY, LANHAM, MD 20706-2487
(240) 505-5427
Mailing address
6500 MANTON WAY, LANHAM, MD 20706-2487
(240) 505-5427
Taxonomy
Speciality
Code
Description
License number
State
261QC1500X
Community Health Clinic/Center
Primary
—
—
363LP0808X
Psychiatric/Mental Health Nurse Practitioner
—
—
Other
Enumeration date
11/11/2020
Last updated
01/26/2021
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