Healthcare Provider Details

I. General information

NPI: 1548838758
Provider Name (Legal Business Name): CLEAR MINDS FAMILY AND MENTAL HEALTH SERVICES LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/14/2021
Last Update Date: 09/06/2023
Certification Date: 05/24/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

11140 ROCKVILLE PIKE STE 590A
ROCKVILLE MD
20852-3183
US

IV. Provider business mailing address

11140 ROCKVILLE PIKE STE 590A
ROCKVILLE MD
20852-3183
US

V. Phone/Fax

Practice location:
  • Phone: 301-580-4776
  • Fax: 301-580-5192
Mailing address:
  • Phone: 301-580-4776
  • Fax: 301-580-5192

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code261QM1300X
TaxonomyMulti-Specialty Clinic/Center
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code261QP2300X
TaxonomyPrimary Care Clinic/Center
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code364SP0812X
TaxonomyCommunity Psychiatric/Mental Health Clinical Nurse Specialist
License Number
License Number State

VIII. Authorized Official

Name: MS. NANCY NYAKUNDI
Title or Position: OWNER
Credential:
Phone: 301-580-4776