Healthcare Provider Details

I. General information

NPI: 1487424115
Provider Name (Legal Business Name): MILDER TOUCH MENTAL HEALTH AND WELLNESS LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/04/2024
Last Update Date: 07/14/2026
Certification Date: 07/14/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

400 E PRATT ST FL 8
BALTIMORE MD
21202-3180
US

IV. Provider business mailing address

5706 GOSSAMER CT
MOSELEY VA
23120-2339
US

V. Phone/Fax

Practice location:
  • Phone: 443-842-4253
  • Fax:
Mailing address:
  • Phone: 540-204-2459
  • 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: MR. OLUWASEYI LADIPUPO SOETAN
Title or Position: NP- PSYCHIATRIC
Credential: PMHNP-BC
Phone: 424-622-8428