Healthcare Provider Details

I. General information

NPI: 1285293340
Provider Name (Legal Business Name): HEALING MINDS, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/11/2019
Last Update Date: 06/11/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4300 BELAIR RD STE C
BALTIMORE MD
21206-6300
US

IV. Provider business mailing address

5 CASEY CT
CATONSVILLE MD
21228-3677
US

V. Phone/Fax

Practice location:
  • Phone: 443-835-4477
  • Fax:
Mailing address:
  • Phone: 410-949-9755
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101Y00000X
TaxonomyCounselor
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code171M00000X
TaxonomyCase Manager/Care Coordinator
License Number
License Number State
# 4
Primary TaxonomyN
Taxonomy Code261QM1300X
TaxonomyMulti-Specialty Clinic/Center
License Number
License Number State
# 5
Primary TaxonomyY
Taxonomy Code261QC1500X
TaxonomyCommunity Health Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: MR. TURNER RASCOE III
Title or Position: COO
Credential:
Phone: 443-708-5699