Healthcare Provider Details

I. General information

NPI: 1194647610
Provider Name (Legal Business Name): NOVAMIND WELLNESS , LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/27/2026
Last Update Date: 07/27/2026
Certification Date: 07/27/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5602 BALTIMORE NATIONAL PIKE STE 300
BALTIMORE MD
21228-1410
US

IV. Provider business mailing address

4883 MELBOURNE RD
BALTIMORE MD
21229-4432
US

V. Phone/Fax

Practice location:
  • Phone: 443-979-4599
  • Fax:
Mailing address:
  • Phone: 443-979-4599
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QM0801X
TaxonomyMental Health Clinic/Center (Including Community Mental Health Center)
License Number
License Number State

VIII. Authorized Official

Name: NICOLE ASHLEY DANTZLER
Title or Position: DIRECTOR
Credential:
Phone: 443-979-4599