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General NPI Number Information
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NPI Number | 1346190238
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Entity Type | Organization
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Legal Business Name | FAIRMIND BEHAVIORAL HEALTH, LLC
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Dates
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Enumeration Date | 01/30/2026
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Last Update Date | 01/30/2026
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Provider Practice Location Address
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Address Line | 4602 JOHN ST
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City | SUITLAND
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State | MD
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Zip | 20746-3771
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Country | US
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Telephone | 443-457-8339
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Fax | 410-907-3189
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Provider Business Mailing Address
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Address Line | 4602 JOHN ST
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City | SUITLAND
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State | MD
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Zip | 20746-3771
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Country | US
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Telephone | 443-457-8339
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Fax | 410-907-3189
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Authorized Official
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Title or Position | PMHNP
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Name | VALENCIA FAIRLEY
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Credential | CRNP-PMH
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Telephone | 443-457-8339
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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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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Taxonomy #2
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Taxonomy Code | 363LP0808X
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Taxonomy Name | Psychiatric/Mental Health Nurse Practitioner
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License Number |
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License Number State |
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