Provider Demographics
NPI:1083178586
Name:MINDFUL HEALING WORKS WELLNESS CENTER, LLC
Entity Type:Organization
Organization Name:MINDFUL HEALING WORKS WELLNESS CENTER, LLC
Other - Org Name:MINDFUL HEALING WORKS WELLNESS CENTER PRP
Other - Org Type:Doing Business As
Authorized Official - Title/Position:BILLING DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:ROSE
Authorized Official - Middle Name:
Authorized Official - Last Name:LYNCH
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:401-649-5754
Mailing Address - Street 1:750 CONCOURSE CIR STE 103-203
Mailing Address - Street 2:
Mailing Address - City:MIDDLE RIVER
Mailing Address - State:MD
Mailing Address - Zip Code:21220-2995
Mailing Address - Country:US
Mailing Address - Phone:443-530-6533
Mailing Address - Fax:443-503-8250
Practice Address - Street 1:1576 MERRITT BLVD STE 8
Practice Address - Street 2:
Practice Address - City:DUNDALK
Practice Address - State:MD
Practice Address - Zip Code:21222-2114
Practice Address - Country:US
Practice Address - Phone:443-530-6533
Practice Address - Fax:443-530-6996
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:MINDFUL HEALING WORKS WELLNESS CENTER, LLC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2019-01-29
Last Update Date:2023-07-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Single Specialty