Provider Demographics
NPI:1285321638
Name:WISE MIND, LLC
Entity type:Organization
Organization Name:WISE MIND, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:SHARON
Authorized Official - Middle Name:T
Authorized Official - Last Name:DAVIS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:410-413-4108
Mailing Address - Street 1:90 PAINTERS MILL RD STE 203
Mailing Address - Street 2:
Mailing Address - City:OWINGS MILLS
Mailing Address - State:MD
Mailing Address - Zip Code:21117-3614
Mailing Address - Country:US
Mailing Address - Phone:410-413-4108
Mailing Address - Fax:410-510-1505
Practice Address - Street 1:90 PAINTERS MILL RD STE 203
Practice Address - Street 2:
Practice Address - City:OWINGS MILLS
Practice Address - State:MD
Practice Address - Zip Code:21117-3614
Practice Address - Country:US
Practice Address - Phone:410-413-4108
Practice Address - Fax:410-510-1505
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:WISE MIND, LLC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2023-04-18
Last Update Date:2023-04-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0801XAmbulatory Health Care FacilitiesClinic/CenterMental Health (Including Community Mental Health Center)
No251S00000XAgenciesCommunity/Behavioral Health
No261Q00000XAmbulatory Health Care FacilitiesClinic/Center
No261QM0850XAmbulatory Health Care FacilitiesClinic/CenterAdult Mental Health
No261QM1300XAmbulatory Health Care FacilitiesClinic/CenterMulti-Specialty