Healthcare Provider Details

I. General information

NPI: 1033687934
Provider Name (Legal Business Name): MINDFUL HEALING WORKS MENTAL HEALTH GROUP PRACTICE
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/08/2018
Last Update Date: 11/08/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7811 WISE AVE
DUNDALK MD
21222-3339
US

IV. Provider business mailing address

11550 CROSSROADS CIR UNIT 461
BALTIMORE MD
21220-2765
US

V. Phone/Fax

Practice location:
  • Phone: 443-504-5316
  • Fax:
Mailing address:
  • Phone: 443-504-5316
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number
License Number State

VIII. Authorized Official

Name: MS. ERIN MEYER
Title or Position: CEO
Credential: LCPC
Phone: 443-504-5316