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General NPI Number Information
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NPI Number | 1639799141
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Entity Type | Organization
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Legal Business Name | INNERMIND SOLUTIONS LLC
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Dates
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Enumeration Date | 04/24/2020
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Last Update Date | 07/12/2025
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Provider Practice Location Address
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Address Line | 915 TOLL HOUSE AVE STE 205
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City | FREDERICK
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State | MD
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Zip | 21701-5901
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Country | US
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Telephone | 443-675-8082
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Fax | 301-732-4271
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Provider Business Mailing Address
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Address Line | 750 MAIN ST STE 412
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City | HARTFORD
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State | CT
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Zip | 06103-2703
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Country | US
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Telephone | 860-815-8799
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Fax | 860-374-4063
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Authorized Official
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Title or Position | CEO
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Name | DR. AYODEJI BAMIDELE OLAWALE
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Credential | DNP
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Telephone | 301-905-2947
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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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