Healthcare Provider Details

I. General information

NPI: 1255141636
Provider Name (Legal Business Name): INNER MIND DEVELOPMENT GROUP, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/08/2025
Last Update Date: 04/21/2026
Certification Date: 04/21/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2 GRANITE AVE STE 260
MILTON MA
02186-4381
US

IV. Provider business mailing address

2 GRANITE AVE STE 260
MILTON MA
02186-4381
US

V. Phone/Fax

Practice location:
  • Phone: 857-203-7001
  • Fax:
Mailing address:
  • Phone: 857-203-7001
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number State

VIII. Authorized Official

Name: MS. DENNA MARY GILOT
Title or Position: OWNER
Credential: LMHC
Phone: 857-203-7001