Healthcare Provider Details

I. General information

NPI: 1245984715
Provider Name (Legal Business Name): BE WELL MENTAL HEALTH SERVICES
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/03/2022
Last Update Date: 02/03/2022
Certification Date: 02/03/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1900 E NORTHERN PKWY STE T7
BALTIMORE MD
21239-2120
US

IV. Provider business mailing address

1 CHATTERLY CT
PERRY HALL MD
21128-9114
US

V. Phone/Fax

Practice location:
  • Phone: 443-858-7764
  • Fax:
Mailing address:
  • Phone: 443-858-7764
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License Number
License Number State

VIII. Authorized Official

Name: MRS. NICOLE D HAWKINS
Title or Position: NURSE PRACTITIONER
Credential: PMHNP-BC
Phone: 443-858-7764