Healthcare Provider Details

I. General information

NPI: 1609716000
Provider Name (Legal Business Name): NIMEL MENTAL HEALTH LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/30/2026
Last Update Date: 03/30/2026
Certification Date: 03/29/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

216 CRAIN HWY N STE 102
GLEN BURNIE MD
21061-3086
US

IV. Provider business mailing address

10801 GREEN ASH LN
BELTSVILLE MD
20705-3851
US

V. Phone/Fax

Practice location:
  • Phone: 301-263-4890
  • Fax:
Mailing address:
  • Phone: 301-263-4890
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code261QM0801X
TaxonomyMental Health Clinic/Center (Including Community Mental Health Center)
License Number
License Number State
# 4
Primary TaxonomyN
Taxonomy Code261QR0800X
TaxonomyRecovery Care Clinic/Center
License Number
License Number State
# 5
Primary TaxonomyN
Taxonomy Code283Q00000X
TaxonomyPsychiatric Hospital
License Number
License Number State

VIII. Authorized Official

Name: MOSUNMOLA SANDRA LAKE
Title or Position: MEDICAL DIRECTOR
Credential:
Phone: 301-272-1558