=====================================================
General NPI Number Information
=====================================================
NPI Number | 1659702280
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | HOPEFUL ORIGINS, LLC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 12/08/2013
-----------------------------------------------------
Last Update Date | 01/25/2025
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 516 N ROLLING RD STE 305
-----------------------------------------------------
City | CATONSVILLE
-----------------------------------------------------
State | MD
-----------------------------------------------------
Zip | 21228-4142
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 410-420-8300
-----------------------------------------------------
Fax | 443-267-0020
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | PO BOX 11
-----------------------------------------------------
City | ABINGDON
-----------------------------------------------------
State | MD
-----------------------------------------------------
Zip | 21009-0011
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 410-420-8300
-----------------------------------------------------
Fax | 443-267-0200
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | OWNER/PROVIDER
-----------------------------------------------------
Name | NADIA SWANSON
-----------------------------------------------------
Credential | NP
-----------------------------------------------------
Telephone | 917-863-5889
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 261QM0850X
-----------------------------------------------------
Taxonomy Name | Adult Mental Health Clinic/Center
-----------------------------------------------------
License Number | R1628686
-----------------------------------------------------
License Number State | MD
-----------------------------------------------------