Healthcare Provider Details

I. General information

NPI: 1386455012
Provider Name (Legal Business Name): TWO MINDS CONNECT, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/14/2025
Last Update Date: 05/24/2025
Certification Date: 05/24/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1655 FORT MYER DR STE 717
ARLINGTON VA
22209-3113
US

IV. Provider business mailing address

7333 NEW HAMPSHIRE AVE APT 214S
TAKOMA PARK MD
20912-6959
US

V. Phone/Fax

Practice location:
  • Phone: 617-820-3196
  • Fax:
Mailing address:
  • Phone: 720-819-3064
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251S00000X
TaxonomyCommunity/Behavioral Health Agency
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code302R00000X
TaxonomyHealth Maintenance Organization
License Number
License Number State

VIII. Authorized Official

Name: ZYAIRE TAYLOR
Title or Position: CO-OWNER
Credential: RN
Phone: 720-819-3064