| Graceland Psychiatry And Wellness | |
|
2137 Streamway Ct Gwynn Oak MD 21207-6093 | |
| (443) 720-9292 | |
| Not Available |
| Full Name | Graceland Psychiatry And Wellness |
|---|---|
| Speciality | Psychiatry & Neurology |
| Location | 2137 Streamway Ct, Gwynn Oak, Maryland |
| Authorized Official Name and Position | Sirah Okoluku (CEO) |
| Authorized Official Contact | 4437209292 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Graceland Psychiatry And Wellness 2137 Streamway Ct Gwynn Oak MD 21207-6093 Ph: (443) 720-9292 | Graceland Psychiatry And Wellness 2137 Streamway Ct Gwynn Oak MD 21207-6093 Ph: (443) 720-9292 |
| NPI Number | 1275204505 |
|---|---|
| Provider Enumeration Date | 09/27/2021 |
| Last Update Date | 09/27/2021 |
| Certification Date | 09/27/2021 |
| Medicare PECOS PAC ID | 4880085109 |
|---|---|
| Medicare Enrollment ID | O20211221002706 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1275204505 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 2084P0800X | Psychiatry & Neurology - Psychiatry | (* (Not Available)) | Primary |
| Provider Name | Sirah L Okoluku |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1942855523 PECOS PAC ID: 3173956893 Enrollment ID: I20211221002790 |
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