Healthcare Provider Details

I. General information

NPI: 1992121552
Provider Name (Legal Business Name): PEACEFUL MIND, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/06/2014
Last Update Date: 01/29/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9701 APOLLO DRIVE SUITE 301
LARGO MD
20774-4790
US

IV. Provider business mailing address

9701 APOLLO DRIVE SUITE 301
LARGO MD
20774-4790
US

V. Phone/Fax

Practice location:
  • Phone: 301-455-8804
  • Fax:
Mailing address:
  • Phone: 301-455-8804
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101Y00000X
TaxonomyCounselor
License NumberLC5573
License Number StateMD
# 2
Primary TaxonomyN
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number
License Number State

VIII. Authorized Official

Name: KARLICE MOSS-TEAMS
Title or Position: OWNER
Credential: LCPC
Phone: 301-455-8804