Healthcare Provider Details

I. General information

NPI: 1609464379
Provider Name (Legal Business Name): HEALING MIND WELLNESS
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/07/2021
Last Update Date: 03/16/2021
Certification Date: 03/16/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

124 SLADE AVE STE 101
PIKESVILLE MD
21208-4900
US

IV. Provider business mailing address

124 SLADE AVE STE 101
PIKESVILLE MD
21208-4900
US

V. Phone/Fax

Practice location:
  • Phone: 410-452-4325
  • Fax: 443-548-2800
Mailing address:
  • Phone: 410-452-4325
  • Fax: 443-548-2800

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code261QM0801X
TaxonomyMental Health Clinic/Center (Including Community Mental Health Center)
License Number
License Number State

VIII. Authorized Official

Name: TYWANNA D HAMILTON
Title or Position: MEDICAL DIRECTOE
Credential: CRNP
Phone: 410-452-4325