Healthcare Provider Details

I. General information

NPI: 1609450576
Provider Name (Legal Business Name): NIMEL MENTAL HEALTH
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/07/2021
Last Update Date: 02/13/2024
Certification Date: 02/13/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6215 GREENBELT RD STE 107
BERWYN HEIGHTS MD
20740-2355
US

IV. Provider business mailing address

10801 GREEN ASH LN
BELTSVILLE MD
20705-3851
US

V. Phone/Fax

Practice location:
  • Phone: 301-272-1558
  • Fax: 301-272-1559
Mailing address:
  • Phone: 301-263-4890
  • 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 StateNULL
# 2
Primary TaxonomyN
Taxonomy Code261QR0800X
TaxonomyRecovery Care Clinic/Center
License Number
License Number StateNULL
# 3
Primary TaxonomyN
Taxonomy Code283Q00000X
TaxonomyPsychiatric Hospital
License Number
License Number StateNULL
# 4
Primary TaxonomyN
Taxonomy Code251S00000X
TaxonomyCommunity/Behavioral Health Agency
License Number
License Number StateNULL

VIII. Authorized Official

Name: MOSUNMOLA SANDRA LAKE
Title or Position: MANAGER
Credential:
Phone: 301-272-1558