Healthcare Provider Details

I. General information

NPI: 1730935990
Provider Name (Legal Business Name): PEACEFUL MINDS THERAPY CENTER
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/29/2024
Last Update Date: 10/07/2024
Certification Date: 10/07/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

14201 LAUREL PARK DR STE 221
LAUREL MD
20707-5203
US

IV. Provider business mailing address

14201 LAUREL PARK DR STE 221
LAUREL MD
20707-5203
US

V. Phone/Fax

Practice location:
  • Phone: 703-712-1049
  • Fax:
Mailing address:
  • Phone: 703-712-1049
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License Number
License Number State

VIII. Authorized Official

Name: DR. PAULINE BELTON
Title or Position: OWNER/CLINICAL DIRECTOR
Credential: LCPC
Phone: 703-712-1049