Healthcare Provider Details

I. General information

NPI: 1093066995
Provider Name (Legal Business Name): HEALTHY MINDS, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/02/2012
Last Update Date: 11/13/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1309 VEALE RD SUITE 21
WILMINGTON DE
19810-4609
US

IV. Provider business mailing address

PO BOX 5353
SPRINGFIELD PA
19064-5353
US

V. Phone/Fax

Practice location:
  • Phone: 302-477-0977
  • Fax:
Mailing address:
  • Phone: 302-477-0977
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101Y00000X
TaxonomyCounselor
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code104100000X
TaxonomySocial Worker
License Number
License Number State
# 4
Primary TaxonomyN
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License Number
License Number State
# 5
Primary TaxonomyY
Taxonomy Code2084P0804X
TaxonomyChild & Adolescent Psychiatry Physician
License Number
License Number State

VIII. Authorized Official

Name: DR. UJWALA DIXIT
Title or Position: CEO, FOUNDER-DIRECTOR
Credential: M.D
Phone: 302-477-0977