Healthcare Provider Details

I. General information

NPI: 1609781640
Provider Name (Legal Business Name): SUPPORTIVE MINDS MENTAL HEALTH SERVICES, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/15/2026
Last Update Date: 09/16/2026
Certification Date: 09/16/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

19650 CLUB HOUSE RD STE 202-A
MONTGOMERY VILLAGE MD
20886-3003
US

IV. Provider business mailing address

11273 SUFFOLK DR
HAGERSTOWN MD
21742-4054
US

V. Phone/Fax

Practice location:
  • Phone: 202-740-4111
  • Fax:
Mailing address:
  • Phone: 240-437-2133
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License Number
License Number State

VIII. Authorized Official

Name: HURLERE VIRGINE NDJOUSSI
Title or Position: PMHNP
Credential: PMHNP
Phone: 240-437-2133