Organization
EVIDENTIAL THERAPY & WELLNESS LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
IYOBOSA JOAN OBASOGIE (CEO)
(667) 303-2771
Entity
Organization
Contact information
Practice address
6 MALLOW CT, NOTTINGHAM, MD 21236-1300
(443) 491-9469
(443) 222-9310
Mailing address
6 MALLOW CT, NOTTINGHAM, MD 21236-1300
Taxonomy
Speciality
Code
Description
License number
State
363LP0808X
Psychiatric/Mental Health Nurse Practitioner
Primary
—
—
Other
Enumeration date
05/23/2025
Last updated
05/23/2025
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