Provider Demographics
NPI:1285385351
Name:HEALING MINDS WELLNESS CENTER, LLC
Entity type:Organization
Organization Name:HEALING MINDS WELLNESS CENTER, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:MS
Authorized Official - First Name:KENYONA
Authorized Official - Middle Name:
Authorized Official - Last Name:DAVIS
Authorized Official - Suffix:
Authorized Official - Credentials:LMSW
Authorized Official - Phone:202-729-0018
Mailing Address - Street 1:1706 MACO DR
Mailing Address - Street 2:
Mailing Address - City:HANOVER
Mailing Address - State:MD
Mailing Address - Zip Code:21076-1399
Mailing Address - Country:US
Mailing Address - Phone:202-729-0018
Mailing Address - Fax:
Practice Address - Street 1:3600 PULASKI HWY
Practice Address - Street 2:
Practice Address - City:BALTIMORE
Practice Address - State:MD
Practice Address - Zip Code:21224-1534
Practice Address - Country:US
Practice Address - Phone:202-729-0018
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-01-11
Last Update Date:2022-01-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes320800000XResidential Treatment FacilitiesCommunity Based Residential Treatment Facility, Mental Illness
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD444622400Medicaid