Healthcare Provider Details

I. General information

NPI: 1053248310
Provider Name (Legal Business Name): REJUVENATING HEARTS & MINDS, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/08/2026
Last Update Date: 05/08/2026
Certification Date: 04/27/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6525 CLUSTER PINE CT.
WALDORF MD
20603
US

IV. Provider business mailing address

3436 BELLWICK BAY DR
SLIDELL LA
70461-3416
US

V. Phone/Fax

Practice location:
  • Phone: 240-229-5348
  • Fax: 855-644-1392
Mailing address:
  • Phone: 240-229-5348
  • Fax: 855-644-1392

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number State

VIII. Authorized Official

Name: TASHA DODSON
Title or Position: CEO
Credential:
Phone: 240-229-5348