Healthcare Provider Details

I. General information

NPI: 1154991768
Provider Name (Legal Business Name): GROW YOUR MIND PSYCHOTHERAPY, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/26/2021
Last Update Date: 12/14/2022
Certification Date: 12/14/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8720 GEORGIA AVE STE 906
SILVER SPRING MD
20910-3635
US

IV. Provider business mailing address

1220 E WEST HWY APT 1216
SILVER SPRING MD
20910-6211
US

V. Phone/Fax

Practice location:
  • Phone: 301-893-4733
  • Fax:
Mailing address:
  • Phone: 301-893-4733
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number
License Number State

VIII. Authorized Official

Name: LINGYING HUANG
Title or Position: DIRECTOR
Credential: LCPC
Phone: 301-893-4733