| Victorious Mental Healthcare Llc | |
|
5006 Belair Rd Baltimore MD 21206-5101 | |
| (443) 540-0338 | |
| Not Available |
| Full Name | Victorious Mental Healthcare Llc |
|---|---|
| Speciality | Community/Behavioral Health |
| Location | 5006 Belair Rd, Baltimore, Maryland |
| Authorized Official Name and Position | Bosede Oluwatoyin Adetunji - Idowu (CEO) |
| Authorized Official Contact | 4435400338 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Victorious Mental Healthcare Llc 5006 Belair Rd Baltimore MD 21206-5101 Ph: (443) 540-0338 | Victorious Mental Healthcare Llc 5006 Belair Rd Baltimore MD 21206-5101 Ph: (443) 540-0338 |
| NPI Number | 1962032995 |
|---|---|
| Provider Enumeration Date | 01/17/2020 |
| Last Update Date | 01/17/2020 |
| Certification Date | 01/17/2020 |
| Medicare PECOS PAC ID | 7719300946 |
|---|---|
| Medicare Enrollment ID | O20200707002307 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1962032995 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 251S00000X | Community/behavioral Health | (* (Not Available)) | Primary |
| Provider Name | Abena Adoko Sando |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1952666885 PECOS PAC ID: 2264681519 Enrollment ID: I20121003000041 |
| Provider Name | Charles Dankwa Sarbeng |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1073642104 PECOS PAC ID: 1658405998 Enrollment ID: I20191031000900 |
| Provider Name | Ruphina Ogechi Nnebedum |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1417455932 PECOS PAC ID: 5597153338 Enrollment ID: I20211027000762 |
| Provider Name | Titilayo Ajayi |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1720732423 PECOS PAC ID: 9830586148 Enrollment ID: I20220504002481 |
| Provider Name | Gladys Ebele Egwuatu |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1841929205 PECOS PAC ID: 7315317989 Enrollment ID: I20221227000013 |
| Provider Name | Erica Johnson |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1861966582 PECOS PAC ID: 9931572583 Enrollment ID: I20230301000585 |
| Provider Name | Kehinde Deborah Joseph |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1518657527 PECOS PAC ID: 5496117889 Enrollment ID: I20230816004309 |
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