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General NPI Number Information
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NPI Number | 1992121552
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Entity Type | Organization
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Legal Business Name | PEACEFUL MIND, LLC
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Dates
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Enumeration Date | 03/06/2014
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Last Update Date | 01/29/2015
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Provider Practice Location Address
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Address Line | 9701 APOLLO DRIVE SUITE 301
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City | LARGO
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State | MD
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Zip | 20774-4790
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Country | US
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Telephone | 301-455-8804
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Fax |
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Provider Business Mailing Address
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Address Line | 9701 APOLLO DRIVE SUITE 301
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City | LARGO
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State | MD
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Zip | 20774-4790
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Country | US
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Telephone | 301-455-8804
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | KARLICE MOSS-TEAMS
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Credential | LCPC
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Telephone | 301-455-8804
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 101YP2500X
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Taxonomy Name | Professional Counselor
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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 | 101Y00000X
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Taxonomy Name | Counselor
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License Number | LC5573
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License Number State | MD
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