=====================================================
General NPI Number Information
=====================================================
NPI Number | 1851233001
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | MINDFUL BRIDGE THERAPY LLC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 04/07/2026
-----------------------------------------------------
Last Update Date | 04/07/2026
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 1814 E LOMBARD ST
-----------------------------------------------------
City | BALTIMORE
-----------------------------------------------------
State | MD
-----------------------------------------------------
Zip | 21231-1814
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 443-406-6464
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 1814 E LOMBARD ST
-----------------------------------------------------
City | BALTIMORE
-----------------------------------------------------
State | MD
-----------------------------------------------------
Zip | 21231-1814
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 443-406-6464
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | OWNER/LCPC
-----------------------------------------------------
Name | JANICE CAROLYN LANG
-----------------------------------------------------
Credential | LCPC
-----------------------------------------------------
Telephone | 443-406-6464
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 261QM0850X
-----------------------------------------------------
Taxonomy Name | Adult Mental Health Clinic/Center
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------