Healthcare Provider Details

I. General information

NPI: 1053252213
Provider Name (Legal Business Name): NIMEL MENTAL HEALTH LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/02/2026
Last Update Date: 04/02/2026
Certification Date: 04/02/2026
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

6215 GREENBELT RD STE 107
BERWYN HEIGHTS MD
20740-2355
US

V. Phone/Fax

Practice location:
  • Phone: 301-272-1558
  • Fax:
Mailing address:
  • Phone: 301-272-1558
  • Fax:

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 Code261QM0801X
TaxonomyMental Health Clinic/Center (Including Community Mental Health Center)
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License Number
License Number State

VIII. Authorized Official

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