Provider Demographics
NPI:1164052270
Name:GROWING MINDS BEHAVIORAL HEALTH
Entity Type:Organization
Organization Name:GROWING MINDS BEHAVIORAL HEALTH
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:ASHLEY
Authorized Official - Middle Name:
Authorized Official - Last Name:SMITH-NONNARATH
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:510-710-0246
Mailing Address - Street 1:106 THOMASSON CT
Mailing Address - Street 2:
Mailing Address - City:CAPITOL HEIGHTS
Mailing Address - State:MD
Mailing Address - Zip Code:20743-3058
Mailing Address - Country:US
Mailing Address - Phone:510-710-0246
Mailing Address - Fax:
Practice Address - Street 1:106 THOMASSON CT
Practice Address - Street 2:
Practice Address - City:CAPITOL HEIGHTS
Practice Address - State:MD
Practice Address - Zip Code:20743-3058
Practice Address - Country:US
Practice Address - Phone:510-710-0246
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-01-17
Last Update Date:2020-12-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health