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General NPI Number Information
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NPI Number | 1609781640
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Entity Type | Organization
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Legal Business Name | SUPPORTIVE MINDS MENTAL HEALTH SERVICES, LLC
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Dates
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Enumeration Date | 08/15/2026
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Last Update Date | 08/15/2026
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Provider Practice Location Address
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Address Line | 19650 CLUB HOUSE RD STE 202-A
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City | MONTGOMERY VILLAGE
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State | MD
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Zip | 20886-3003
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Country | US
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Telephone | 202-740-4111
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Fax |
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Provider Business Mailing Address
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Address Line | 11273 SUFFOLK DR
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City | HAGERSTOWN
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State | MD
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Zip | 21742-4054
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Country | US
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Telephone | 240-437-2133
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Fax |
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Authorized Official
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Title or Position | PMHNP
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Name | HURLERE VIRGINE NDJOUSSI
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Credential | PMHNP
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Telephone | 240-437-2133
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 2084P0800X
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Taxonomy Name | Psychiatry Physician
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License Number |
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License Number State |
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