Healthcare Provider Details

I. General information

NPI: 1235051046
Provider Name (Legal Business Name): GRATEFUL MIND WELLNESS & BEHAVIORAL HEALTH SERVICES
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/27/2026
Last Update Date: 07/27/2026
Certification Date: 07/26/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8641 LOCH RAVEN BLVD STE 3A3B
TOWSON MD
21286-2310
US

IV. Provider business mailing address

8641 LOCH RAVEN BLVD STE 3A3B
TOWSON MD
21286-2310
US

V. Phone/Fax

Practice location:
  • Phone: 443-992-5313
  • Fax:
Mailing address:
  • Phone: 443-992-5313
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QR0405X
TaxonomySubstance Use Disorder Rehabilitation Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: CARLINE BEVERLY
Title or Position: OWNER/MANAGING MEMBER
Credential: RN, BSN
Phone: 443-992-5313