Healthcare Provider Details

I. General information

NPI: 1578418976
Provider Name (Legal Business Name): SURE MIND HEALTH LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/02/2026
Last Update Date: 03/02/2026
Certification Date: 03/02/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8827 MONTJOY PL
ELLICOTT CITY MD
21043-8003
US

IV. Provider business mailing address

8827 MONTJOY PL
ELLICOTT CITY MD
21043-8003
US

V. Phone/Fax

Practice location:
  • Phone: 757-781-9991
  • Fax: 443-212-9417
Mailing address:
  • Phone: 757-781-9991
  • Fax: 443-212-9417

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: MS. OLORUNKEMI AJOKE FEYISOLA
Title or Position: PMHNP
Credential: NP
Phone: 757-781-9991