Healthcare Provider Details

I. General information

NPI: 1619672383
Provider Name (Legal Business Name): NEW ERA MIND WELLNESS
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/03/2023
Last Update Date: 04/03/2023
Certification Date: 04/03/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9801 GEORGIA AVE STE 224
SILVER SPRING MD
20902-5276
US

IV. Provider business mailing address

9801 GEORGIA AVE STE 224
SILVER SPRING MD
20902-5276
US

V. Phone/Fax

Practice location:
  • Phone: 410-908-6207
  • Fax:
Mailing address:
  • Phone: 410-908-6207
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QM0850X
TaxonomyAdult Mental Health Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: MR. CHINEDU OFOR
Title or Position: DIRECTOR
Credential: CRNP-PMH
Phone: 410-908-6207