Provider Demographics
NPI:1184218596
Name:HEALTHY MIND FOUNDATION
Entity Type:Organization
Organization Name:HEALTHY MIND FOUNDATION
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:DR
Authorized Official - First Name:KENNETH
Authorized Official - Middle Name:
Authorized Official - Last Name:UWAJEH
Authorized Official - Suffix:
Authorized Official - Credentials:MD MPH
Authorized Official - Phone:443-927-6186
Mailing Address - Street 1:4629 DEEPWOOD CT
Mailing Address - Street 2:
Mailing Address - City:BOWIE
Mailing Address - State:MD
Mailing Address - Zip Code:20720-3488
Mailing Address - Country:US
Mailing Address - Phone:443-927-6186
Mailing Address - Fax:
Practice Address - Street 1:8101 SANDY SPRING RD STE 300-W29
Practice Address - Street 2:
Practice Address - City:LAUREL
Practice Address - State:MD
Practice Address - Zip Code:20707-3596
Practice Address - Country:US
Practice Address - Phone:443-927-6186
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-02-25
Last Update Date:2021-02-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
1477112050OtherNPPES