Healthcare Provider Details

I. General information

NPI: 1528448404
Provider Name (Legal Business Name): HEALTHY MINDS RESOURCE SERVICES
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/04/2015
Last Update Date: 11/19/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1800 N CHARLES ST STE 804
BALTIMORE MD
21201-5920
US

IV. Provider business mailing address

500 REDLAND CT STE 213
OWINGS MILLS MD
21117-3264
US

V. Phone/Fax

Practice location:
  • Phone: 410-363-3713
  • Fax:
Mailing address:
  • Phone: 410-625-5088
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License NumberATC110
License Number StateMD
# 2
Primary TaxonomyN
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License NumberLC3003
License Number StateMD
# 3
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number404629300
License Number StateMD

VIII. Authorized Official

Name: TIFFINIE CARROLL
Title or Position: EXECUTIVE DIRECTOR
Credential:
Phone: 410-363-3713