Provider Demographics
NPI:1083411896
Name:SEA GLASS BEHAVIORAL HEALTH, LLC
Entity type:Organization
Organization Name:SEA GLASS BEHAVIORAL HEALTH, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER, PROVIDER
Authorized Official - Prefix:
Authorized Official - First Name:JULIE
Authorized Official - Middle Name:ANNE
Authorized Official - Last Name:KINHART
Authorized Official - Suffix:
Authorized Official - Credentials:CRNP-PMH
Authorized Official - Phone:443-366-4385
Mailing Address - Street 1:1147 S. SALISBURY BLVD
Mailing Address - Street 2:SUITE 8 281
Mailing Address - City:SALISBURY
Mailing Address - State:MD
Mailing Address - Zip Code:21801-6865
Mailing Address - Country:US
Mailing Address - Phone:410-979-8902
Mailing Address - Fax:443-313-6948
Practice Address - Street 1:1147 S. SALISBURY BLVD
Practice Address - Street 2:SUITE 8 281
Practice Address - City:SALISBURY
Practice Address - State:MD
Practice Address - Zip Code:21801-6865
Practice Address - Country:US
Practice Address - Phone:410-979-8902
Practice Address - Fax:443-313-6948
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2025-02-27
Last Update Date:2025-04-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental HealthGroup - Single Specialty