Provider Demographics
NPI:1962109488
Name:TRANSFORMING YOUR MIND, LLC
Entity type:Organization
Organization Name:TRANSFORMING YOUR MIND, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/ SOCIAL WORKER
Authorized Official - Prefix:
Authorized Official - First Name:FORMKA
Authorized Official - Middle Name:
Authorized Official - Last Name:JOHNSON
Authorized Official - Suffix:
Authorized Official - Credentials:LCSW-C
Authorized Official - Phone:443-991-1370
Mailing Address - Street 1:1113 E PRESTON ST
Mailing Address - Street 2:
Mailing Address - City:BALTIMORE
Mailing Address - State:MD
Mailing Address - Zip Code:21202-5621
Mailing Address - Country:US
Mailing Address - Phone:443-991-1370
Mailing Address - Fax:
Practice Address - Street 1:1 E CHASE ST STE
Practice Address - Street 2:209 212 213 215
Practice Address - City:BALTIMOR
Practice Address - State:MD
Practice Address - Zip Code:21202-2526
Practice Address - Country:US
Practice Address - Phone:443-991-1370
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-02-15
Last Update Date:2023-08-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0801XAmbulatory Health Care FacilitiesClinic/CenterMental Health (Including Community Mental Health Center)