Healthcare Provider Details

I. General information

NPI: 1235704313
Provider Name (Legal Business Name): NIMEL MENTAL HEALTH
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/21/2021
Last Update Date: 05/21/2021
Certification Date: 05/10/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1004 LITTLESTOWN PIKE STE A1
WESTMINSTER MD
21157-3042
US

IV. Provider business mailing address

10801 GREEN ASH LN
BELTSVILLE MD
20705-3851
US

V. Phone/Fax

Practice location:
  • Phone: 410-386-1180
  • Fax: 410-386-1185
Mailing address:
  • Phone: 301-263-4890
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code251S00000X
TaxonomyCommunity/Behavioral Health Agency
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code261QM0801X
TaxonomyMental Health Clinic/Center (Including Community Mental Health Center)
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code261QR0800X
TaxonomyRecovery Care Clinic/Center
License Number
License Number State
# 4
Primary TaxonomyN
Taxonomy Code283Q00000X
TaxonomyPsychiatric Hospital
License Number
License Number State

VIII. Authorized Official

Name: MOSUNMOLA SANDRA LAKE
Title or Position: MANAGER
Credential:
Phone: 301-272-1558