| Montgomery Wellness Hub Llc | |
|
951 Russell Ave Ste D Gaithersburg MD 20879-3283 | |
| (301) 404-7336 | |
| Not Available |
| Full Name | Montgomery Wellness Hub Llc |
|---|---|
| Speciality | Psychiatry & Neurology |
| Location | 951 Russell Ave Ste D, Gaithersburg, Maryland |
| Authorized Official Name and Position | Mohammed Kolawole Ibrahim (CEO) |
| Authorized Official Contact | 3014047336 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Montgomery Wellness Hub Llc 951 Russell Ave Ste D Gaithersburg MD 20879-3283 Ph: (301) 404-7336 | Montgomery Wellness Hub Llc 951 Russell Ave Ste D Gaithersburg MD 20879-3283 Ph: (301) 404-7336 |
| NPI Number | 1679236954 |
|---|---|
| Provider Enumeration Date | 10/14/2021 |
| Last Update Date | 10/14/2021 |
| Certification Date | 10/14/2021 |
| Medicare PECOS PAC ID | 3173062569 |
|---|---|
| Medicare Enrollment ID | O20240829001653 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1679236954 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 2084B0040X | Psychiatry & Neurology - Behavioral Neurology & Neuropsychiatry | (* (Not Available)) | Primary |
| Provider Name | Chantal Ameyo Hlontor |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1184265712 PECOS PAC ID: 6002359403 Enrollment ID: I20240613002229 |
| Provider Name | Donna L Stefanick |
|---|---|
| Provider Type | Practitioner - Mental Health Counselor |
| Provider Identifiers | NPI Number: 1245662014 PECOS PAC ID: 7012368327 Enrollment ID: I20240830001065 |
| Provider Name | Vincentia Yamson |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1629766563 PECOS PAC ID: 8022542208 Enrollment ID: I20241111002058 |
| Provider Name | Tonilee Lucchino |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1821445545 PECOS PAC ID: 3779989793 Enrollment ID: I20241112003469 |
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