Healthcare Provider Details

I. General information

NPI: 1679201719
Provider Name (Legal Business Name): JOURNEY TO WELLNESS MENTAL HEALTH SERVICES, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/08/2022
Last Update Date: 08/08/2022
Certification Date: 08/08/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9711 WASHINGTONIAN BLVD STE 550
GAITHERSBURG MD
20878-5789
US

IV. Provider business mailing address

9711 WASHINGTONIAN BLVD STE 550
GAITHERSBURG MD
20878-5789
US

V. Phone/Fax

Practice location:
  • Phone: 240-255-9804
  • Fax: 240-348-8923
Mailing address:
  • Phone: 240-255-9804
  • Fax: 240-348-8923

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: DR. CIARA MICHELLE SMITH
Title or Position: PMHNP-BC
Credential: DNP, CRNP
Phone: 240-255-9804