Healthcare Provider Details

I. General information

NPI: 1922793736
Provider Name (Legal Business Name): STRONG MYNDS ORG INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/07/2023
Last Update Date: 04/11/2023
Certification Date: 04/11/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9426 STEWARTOWN RD STE 3B
GAITHERSBURG MD
20879-1601
US

IV. Provider business mailing address

509 QUINCE ORCHARD RD # 224
GAITHERSBURG MD
20878-1435
US

V. Phone/Fax

Practice location:
  • Phone: 915-474-2344
  • Fax: 601-510-9291
Mailing address:
  • Phone: 915-474-2344
  • Fax: 601-510-9291

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License Number
License Number State
# 4
Primary TaxonomyN
Taxonomy Code103TC1900X
TaxonomyCounseling Psychologist
License Number
License Number State
# 5
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number
License Number State
# 6
Primary TaxonomyN
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License Number
License Number State

VIII. Authorized Official

Name: ROGENIA PARKER
Title or Position: CEO
Credential: LCSW
Phone: 601-497-7551