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General NPI Number Information
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NPI Number | 1609449677
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Entity Type | Organization
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Legal Business Name | LIGHT AND MIND WELLNESS LLC
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Dates
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Enumeration Date | 07/19/2021
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Last Update Date | 01/25/2025
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Provider Practice Location Address
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Address Line | 8707 COMMERCE DR STE E
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City | EASTON
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State | MD
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Zip | 21601-6910
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Country | US
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Telephone | 410-855-4664
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Fax | 855-461-3481
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Provider Business Mailing Address
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Address Line | 8707 COMMERCE DR STE E
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City | EASTON
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State | MD
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Zip | 21601-6910
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Country | US
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Telephone | 443-239-2033
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Fax | 855-461-3481
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Authorized Official
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Title or Position | OWNER/PROVIDER
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Name | AISHA HASSAN-DAVIS
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Credential | CNS,PMH-NP, APRN
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Telephone | 443-239-2033
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363L00000X
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Taxonomy Name | Nurse Practitioner
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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 | 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 #3
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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 #4
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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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Taxonomy #5
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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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