Healthcare Provider Details

I. General information

NPI: 1689501710
Provider Name (Legal Business Name): THERAPEUTIC JOURNEY ALLIANCE
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/05/2026
Last Update Date: 05/07/2026
Certification Date: 05/07/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5 PUBLIC SQ STE 301-1030
HAGERSTOWN MD
21740-5528
US

IV. Provider business mailing address

5 PUBLIC SQ STE 301
HAGERSTOWN MD
21740-5597
US

V. Phone/Fax

Practice location:
  • Phone: 681-533-0930
  • Fax:
Mailing address:
  • Phone:
  • 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: DR. QWEEN TI'YE
Title or Position: PSYCHOPHARMACOLOGIST
Credential: APRN-CNP PMHNP-BC
Phone: 681-000-0000