Healthcare Provider Details

I. General information

NPI: 1619881976
Provider Name (Legal Business Name): MIND PRISM BEHAVIORAL HEALTH LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/01/2026
Last Update Date: 10/01/2026
Certification Date: 10/01/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9470 ANNAPOLIS RD STE 305
LANHAM MD
20706-3022
US

IV. Provider business mailing address

9470 ANNAPOLIS RD STE 305
LANHAM MD
20706-3022
US

V. Phone/Fax

Practice location:
  • Phone: 678-595-3480
  • 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 StateNULL

VIII. Authorized Official

Name: MRS. JEMAH V PARKER
Title or Position: OWNER/PROVIDER
Credential: APRN, PMHNP-BC
Phone: 678-595-3480