Healthcare Provider Details

I. General information

NPI: 1467362483
Provider Name (Legal Business Name): THE MIND'S HARBOR
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/10/2026
Last Update Date: 09/10/2026
Certification Date: 09/10/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3415 BREWERS GREEN WAY
BALTIMORE MD
21224-5385
US

IV. Provider business mailing address

3415 BREWERS GREEN WAY
BALTIMORE MD
21224-5385
US

V. Phone/Fax

Practice location:
  • Phone: 216-403-1171
  • Fax:
Mailing address:
  • Phone:
  • 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: ARIANNA STAFFORD
Title or Position: COUNSELOR
Credential: LCPC
Phone: 216-403-1171