Healthcare Provider Details

I. General information

NPI: 1548824220
Provider Name (Legal Business Name): SOUND MIND ASSOCIATES, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/27/2019
Last Update Date: 04/27/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

15416 SYMONDSBURY WAY
UPPER MARLBORO MD
20774-8052
US

IV. Provider business mailing address

15416 SYMONDSBURY WAY
UPPER MARLBORO MD
20774-8052
US

V. Phone/Fax

Practice location:
  • Phone: 240-381-5127
  • Fax:
Mailing address:
  • Phone: 240-381-5127
  • 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. GREGORY ALLEN ROBERTS JR.
Title or Position: FOUNDER/CEO
Credential: NCC, LPC
Phone: 240-381-5127