Provider Demographics
NPI:1831820190
Name:PEACE RAIN PMH LLC
Entity type:Organization
Organization Name:PEACE RAIN PMH LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DR. PMHNP, DNP
Authorized Official - Prefix:
Authorized Official - First Name:AFUA
Authorized Official - Middle Name:BIYAH
Authorized Official - Last Name:ADDO
Authorized Official - Suffix:
Authorized Official - Credentials:PMHNP
Authorized Official - Phone:804-503-7874
Mailing Address - Street 1:12163 FORMBY ST
Mailing Address - Street 2:
Mailing Address - City:BRISTOW
Mailing Address - State:VA
Mailing Address - Zip Code:20136-2031
Mailing Address - Country:US
Mailing Address - Phone:804-503-7874
Mailing Address - Fax:
Practice Address - Street 1:8261 SHOPPERS SQ
Practice Address - Street 2:
Practice Address - City:MANASSAS
Practice Address - State:VA
Practice Address - Zip Code:20111-2176
Practice Address - Country:US
Practice Address - Phone:804-503-7874
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-06-18
Last Update Date:2022-06-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental HealthGroup - Single Specialty