Ahmed Adetola

Individual provider Active NPI Psychologist · Nottingham, MD

NPI 1003529520 · NPPES record last updated Aug 30, 2024

Key facts

NPI
1003529520
Entity type
Individual (NPI type 1)
Primary specialty
Psychologist 103T00000X
Practice address
42 Henry Ave
Nottingham, MD 21236-4203
Phone
(570) 591-1738
NPI assigned
Dec 29, 2022
Sex
Male
Sole proprietor
Yes

Organizations & group practices 3

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

Medicare participation

Medicare fee-for-service enrollment
Not listed in the public Medicare enrollment file

National Provider Directory

Medicare enrollment (NPD)
Yes

Practice roles

OrganizationSpecialtyStatusNew patients
Peak Wellness Therapeutic Services Current
since Aug 1, 2024
Accepting new patients
Venus & Mars Psychotherapy, L.L.C. Past
since Jan 1, 2023
Accepting new patients
Harmony Holistic LLC Psychologist Past
since Jan 1, 2023
Accepting new patients

Specialties & licenses

Specialty (taxonomy)CodeLicenseStatePrimary
Psychologist 103T00000X Yes

Addresses

Primary practice location

42 Henry Ave
Nottingham, MD 21236-4203

Mailing address

42 Henry Ave
Nottingham, MD 21236-4203
Phone (570) 591-1738

Other providers in Nottingham, MD

All providers in Nottingham, MD · Psychologist in Maryland

Sources for this page

Verify at the official NPI Registry.