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General NPI Number Information
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NPI Number | 1568325546
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Entity Type | Organization
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Legal Business Name | MINDFUL HAVEN LLC
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Dates
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Enumeration Date | 12/05/2025
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Last Update Date | 12/05/2025
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Provider Practice Location Address
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Address Line | 9524 BELAIR RD
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City | NOTTINGHAM
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State | MD
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Zip | 21236-1544
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Country | US
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Telephone | 410-630-8292
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Fax |
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Provider Business Mailing Address
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Address Line | 200 CONTINENTAL DR STE 401
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City | NEWARK
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State | DE
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Zip | 19713-4337
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | CO-OWNER
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Name | LATOYA VICTOR
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Credential |
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Telephone | 667-204-7300
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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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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