| Mjb Holistic And Therapeutic Services | |
|
1300 Mercantile Ln Ste 129-14 Upper Marlboro MD 20774-5327 | |
| (301) 381-3622 | |
| Not Available |
| Full Name | Mjb Holistic And Therapeutic Services |
|---|---|
| Speciality | Community/Behavioral Health |
| Location | 1300 Mercantile Ln Ste 129-14, Upper Marlboro, Maryland |
| Authorized Official Name and Position | Melveena Johnson-bolden (CEO/NURSE PRACTITIONER) |
| Authorized Official Contact | 2403011034 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Mjb Holistic And Therapeutic Services 1300 Mercantile Ln Ste 129-14 Upper Marlboro MD 20774-5327 Ph: (301) 381-3622 | Mjb Holistic And Therapeutic Services 1300 Mercantile Ln Ste 129-14 Upper Marlboro MD 20774-5327 Ph: (301) 381-3622 |
| NPI Number | 1093469231 |
|---|---|
| Provider Enumeration Date | 02/07/2022 |
| Last Update Date | 05/22/2023 |
| Certification Date | 05/22/2023 |
| Medicare PECOS PAC ID | 2961867429 |
|---|---|
| Medicare Enrollment ID | O20230505001079 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1093469231 | NPI | - | NPPES |
| B435599428868 | Other | MD | DRIVERS LIC |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 251S00000X | Community/behavioral Health | (* (Not Available)) | Primary |
| 261QC1500X | Clinic/center - Community Health | (* (Not Available)) | Secondary |
| Provider Name | Melveena Johnson-bolden |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1922761956 PECOS PAC ID: 1456736404 Enrollment ID: I20230406000409 |
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