Healthcare Provider Details

I. General information

NPI: 1568372662
Provider Name (Legal Business Name): INNOVATIVE MIND BEHAVIORAL HEALTH SERVICES LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/10/2026
Last Update Date: 09/10/2026
Certification Date: 09/10/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4 S MCCAIN DR STE 9
FREDERICK MD
21703-6093
US

IV. Provider business mailing address

4 S MCCAIN DR STE 9
FREDERICK MD
21703-6093
US

V. Phone/Fax

Practice location:
  • Phone: 240-795-1746
  • Fax:
Mailing address:
  • Phone: 240-795-1746
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code364SC1501X
TaxonomyCommunity Health/Public Health Clinical Nurse Specialist
License Number
License Number State

VIII. Authorized Official

Name: OLUWATOSIN AROWOSEGBE
Title or Position: CEO
Credential:
Phone: 240-795-1746