Healthcare Provider Details

I. General information

NPI: 1538016944
Provider Name (Legal Business Name): MIND BODY CARE LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/13/2026
Last Update Date: 03/13/2026
Certification Date: 03/09/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

628 WARWICK RD
BALTIMORE MD
21229-4707
US

IV. Provider business mailing address

628 WARWICK RD
BALTIMORE MD
21229-4707
US

V. Phone/Fax

Practice location:
  • Phone: 301-615-1566
  • Fax:
Mailing address:
  • Phone: 443-756-7538
  • 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: TRISHA MICHELE CHASON
Title or Position: OWNER/COUNSELOR
Credential: LCPC
Phone: 301-615-1566