Healthcare Provider Details

I. General information

NPI: 1083411896
Provider Name (Legal Business Name): SEA GLASS BEHAVIORAL HEALTH, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/27/2025
Last Update Date: 05/11/2026
Certification Date: 05/11/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

617 FRANKLIN AVE UNIT 7
BERLIN MD
21811-1358
US

IV. Provider business mailing address

617 FRANKLIN AVE UNIT 7
BERLIN MD
21811-1358
US

V. Phone/Fax

Practice location:
  • Phone: 410-979-8902
  • Fax: 443-313-6948
Mailing address:
  • Phone: 410-979-8902
  • Fax: 443-313-6948

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: JULIE ANNE KINHART
Title or Position: PMHNP-BC
Credential:
Phone: 443-366-4385