Healthcare Provider Details

I. General information

NPI: 1306741434
Provider Name (Legal Business Name): SOLACE MIND & WELLNESS
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/09/2026
Last Update Date: 10/09/2026
Certification Date: 10/09/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9504 LIBERTY RD
RANDALLSTOWN MD
21133-2704
US

IV. Provider business mailing address

9603 DEERECO RD UNIT 5316
TIMONIUM MD
21094-7575
US

V. Phone/Fax

Practice location:
  • Phone: 410-357-1121
  • Fax:
Mailing address:
  • Phone: 410-357-1121
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License Number
License Number StateNULL

VIII. Authorized Official

Name: SHAYLA EVANS
Title or Position: OFFICE STAFF
Credential: NP
Phone: 410-357-1121