Organization
DIVINE WELLNESS INC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MR. OLUSEGUN ADEWALE SOFOWOTE LPN (EXECUTIVE DIRECTOR)
(443) 272-2207
Entity
Organization
Contact information
Practice address
9633 LIBERTY RD STE K, RANDALLSTOWN, MD 21133-2435
(443) 272-2207
Mailing address
9633 LIBERTY RD STE K, RANDALLSTOWN, MD 21133-2435
(443) 272-2207
Taxonomy
Speciality
Code
Description
License number
State
261QM0850X
Adult Mental Health Clinic/Center
Primary
—
—
Other
Enumeration date
06/03/2019
Last updated
06/03/2019
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