Healthcare Provider Details

I. General information

NPI: 1083445456
Provider Name (Legal Business Name): MINDFULL HEALING COLLECTIVE LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/08/2024
Last Update Date: 07/16/2026
Certification Date: 07/16/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2411 CROFTON LN STE 4A
CROFTON MD
21114-1337
US

IV. Provider business mailing address

2633 SEYCHELLES CIR UNIT 2303
NAPLES FL
34112-2899
US

V. Phone/Fax

Practice location:
  • Phone: 301-971-4532
  • Fax: 667-803-0057
Mailing address:
  • Phone: 301-971-4532
  • Fax: 667-803-0057

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number State

VIII. Authorized Official

Name: BARRY A CONTEE
Title or Position: OFFICE MANAGER
Credential:
Phone: 301-971-4532