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General NPI Number Information
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NPI Number | 1407576853
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Entity Type | Organization
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Legal Business Name | N.E. BEAUTIFUL MIND, LLC
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Dates
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Enumeration Date | 08/29/2022
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Last Update Date | 11/09/2022
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Provider Practice Location Address
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Address Line | 1050 30TH ST NW # 107
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City | WASHINGTON
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State | DC
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Zip | 20007-3822
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Country | US
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Telephone | 301-640-0300
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Fax |
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Provider Business Mailing Address
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Address Line | 3210 WINTERBOURNE DR
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City | UPPER MARLBORO
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State | MD
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Zip | 20774-9084
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Country | US
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Telephone | 202-246-8323
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Fax |
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Authorized Official
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Title or Position | OWNER/CLINICAL THERAPIST
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Name | MRS. JERNAE DICKENS
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Credential | LPC, NCC
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Telephone | 301-640-0300
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QM0850X
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Taxonomy Name | Adult Mental Health Clinic/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 | 261QM0855X
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Taxonomy Name | Adolescent and Children Mental Health Clinic/Center
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License Number |
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License Number State |
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