Provider Demographics
NPI:1932926102
Name:MINDFULBALANCED PSYCHIATRIC LLC
Entity type:Organization
Organization Name:MINDFULBALANCED PSYCHIATRIC LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:ADANNA
Authorized Official - Middle Name:
Authorized Official - Last Name:IKWUEGBU
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:443-449-3941
Mailing Address - Street 1:9722 GROFFS MILL DR STE 1040
Mailing Address - Street 2:
Mailing Address - City:OWINGS MILLS
Mailing Address - State:MD
Mailing Address - Zip Code:21117-6341
Mailing Address - Country:US
Mailing Address - Phone:443-449-3941
Mailing Address - Fax:
Practice Address - Street 1:9506 LYONSWOOD DR
Practice Address - Street 2:
Practice Address - City:OWINGS MILLS
Practice Address - State:MD
Practice Address - Zip Code:21117-4714
Practice Address - Country:US
Practice Address - Phone:443-449-3941
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-09-20
Last Update Date:2024-09-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental HealthGroup - Multi-Specialty