Healthcare Provider Details

I. General information

NPI: 1912844861
Provider Name (Legal Business Name): CIRCLE OF TRUST INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/29/2026
Last Update Date: 04/29/2026
Certification Date: 04/29/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9812 PEMBROKE DR
HAGERSTOWN MD
21740-1576
US

IV. Provider business mailing address

9812 PEMBROKE DR
HAGERSTOWN MD
21740-1576
US

V. Phone/Fax

Practice location:
  • Phone: 240-513-2692
  • Fax:
Mailing address:
  • Phone: 240-513-2692
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number State

VIII. Authorized Official

Name: DR. DYLLIS MINANG
Title or Position: CLINICAL DIRECTOR
Credential:
Phone: 832-519-7395