Provider Demographics
NPI:1568293728
Name:MIND MAP WELLNESS LLC
Entity type:Organization
Organization Name:MIND MAP WELLNESS LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:SOLE MEMBER/OWNER
Authorized Official - Prefix:
Authorized Official - First Name:IAN
Authorized Official - Middle Name:JAMES
Authorized Official - Last Name:BOLLAND
Authorized Official - Suffix:
Authorized Official - Credentials:LCPS
Authorized Official - Phone:410-929-1499
Mailing Address - Street 1:3030 GREENMOUNTE AVE
Mailing Address - Street 2:STE 300 PMB 183594
Mailing Address - City:BALTIMORE
Mailing Address - State:MD
Mailing Address - Zip Code:21218
Mailing Address - Country:US
Mailing Address - Phone:410-929-1499
Mailing Address - Fax:
Practice Address - Street 1:53 WANOMA CIRCLE
Practice Address - Street 2:
Practice Address - City:REHOBOTH BEACH
Practice Address - State:DE
Practice Address - Zip Code:19971-7704
Practice Address - Country:US
Practice Address - Phone:410-929-1499
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-08-09
Last Update Date:2024-08-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MDLC9569OtherLICENSED CLINICAL PROFESSIONAL COUNSELOR