Healthcare Provider Details

I. General information

NPI: 1932972825
Provider Name (Legal Business Name): MY HEALED MIND LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/01/2023
Last Update Date: 07/30/2026
Certification Date: 07/30/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6325 WOODSIDE CT STE 200-1011
COLUMBIA MD
21046-1017
US

IV. Provider business mailing address

4800 ADDISON RD
CAPITOL HEIGHTS MD
20743-1042
US

V. Phone/Fax

Practice location:
  • Phone: 646-926-4682
  • Fax:
Mailing address:
  • Phone: 646-926-4682
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number
License Number State

VIII. Authorized Official

Name: MS. NAKIA WATSON
Title or Position: CEO
Credential: LICSW
Phone: 646-926-4682