Healthcare Provider Details

I. General information

NPI: 1255192969
Provider Name (Legal Business Name): MINDCARE WELLNESS LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/19/2024
Last Update Date: 01/19/2024
Certification Date: 01/19/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4656 RIVERSTONE DR APT 201
OWINGS MILLS MD
21117-6991
US

IV. Provider business mailing address

4656 RIVERSTONE DR APT 201
OWINGS MILLS MD
21117-6991
US

V. Phone/Fax

Practice location:
  • Phone: 443-418-8356
  • Fax:
Mailing address:
  • Phone: 443-418-8356
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QM0801X
TaxonomyMental Health Clinic/Center (Including Community Mental Health Center)
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License Number
License Number State

VIII. Authorized Official

Name: AMARACHI CHIGBU
Title or Position: PRESIDENT
Credential: OMHNP
Phone: 443-418-8356