Healthcare Provider Details

I. General information

NPI: 1710816715
Provider Name (Legal Business Name): MINDFULPATHDC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/15/2026
Last Update Date: 05/15/2026
Certification Date: 05/15/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2102 LUGINE AVE
GWYNN OAK MD
21207-4415
US

IV. Provider business mailing address

2102 LUGINE AVE
GWYNN OAK MD
21207-4415
US

V. Phone/Fax

Practice location:
  • Phone: 410-900-3819
  • Fax: 443-384-5250
Mailing address:
  • Phone: 410-900-3819
  • Fax:

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: MRS. ANN MARIA STEWART
Title or Position: CEO
Credential: NURSE PRACTITIONER
Phone: 410-900-3819