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General NPI Number Information
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NPI Number | 1295332351
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Entity Type | Organization
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Legal Business Name | HEALING MINDS WELLNESS CENTER, LLC
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Dates
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Enumeration Date | 10/02/2020
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Last Update Date | 10/02/2020
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Provider Practice Location Address
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Address Line | 3600 PULASKI HWY
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City | BALTIMORE
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State | MD
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Zip | 21224-1534
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Country | US
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Telephone | 443-961-7523
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Fax |
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Provider Business Mailing Address
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Address Line | 3600 PULASKI HWY
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City | BALTIMORE
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State | MD
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Zip | 21224-1534
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Country | US
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Telephone | 443-961-7523
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Fax |
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Authorized Official
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Title or Position | CEO/PRESIDENT
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Name | KENYONA DAVIS
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Credential | LMSW
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Telephone | 443-961-7523
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 101YA0400X
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Taxonomy Name | Addiction (Substance Use Disorder) Counselor
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 251S00000X
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Taxonomy Name | Community/Behavioral Health Agency
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License Number |
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License Number State |
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Taxonomy #3
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Taxonomy Code | 261QR0405X
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Taxonomy Name | Substance Use Disorder Rehabilitation Clinic/Center
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License Number |
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License Number State |
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Taxonomy #4
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Taxonomy Code | 261QM0801X
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Taxonomy Name | Mental Health Clinic/Center (Including Community Mental Health Center)
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License Number |
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License Number State |
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