Provider Demographics
| NPI: | 1275054793 |
|---|---|
| Name: | WISE MIND, LLC |
| Entity Type: | Organization |
| Organization Name: | WISE MIND, LLC |
| Other - Org Name: | |
| Other - Org Type: | |
| Authorized Official - Title/Position: | OWNER |
| Authorized Official - Prefix: | |
| Authorized Official - First Name: | SHARON |
| Authorized Official - Middle Name: | T |
| Authorized Official - Last Name: | DAVIS |
| Authorized Official - Suffix: | |
| Authorized Official - Credentials: | LCSW-C |
| Authorized Official - Phone: | 410-413-4108 |
| Mailing Address - Street 1: | 90 PAINTERS MILL RD STE 203 |
| Mailing Address - Street 2: | |
| Mailing Address - City: | OWINGS MILLS |
| Mailing Address - State: | MD |
| Mailing Address - Zip Code: | 21117-3614 |
| Mailing Address - Country: | US |
| Mailing Address - Phone: | 410-413-4108 |
| Mailing Address - Fax: | 410-510-1505 |
| Practice Address - Street 1: | 90 PAINTERS MILL RD STE 203 |
| Practice Address - Street 2: | |
| Practice Address - City: | OWINGS MILLS |
| Practice Address - State: | MD |
| Practice Address - Zip Code: | 21117-3614 |
| Practice Address - Country: | US |
| Practice Address - Phone: | 410-413-4108 |
| Practice Address - Fax: | 410-510-1505 |
| EIN: | <UNAVAIL> |
| Is Organization Subpart?: | No |
| Parent Organization LBN: | |
| Parent Organization TIN: | |
| Enumeration Date: | 2017-07-06 |
| Last Update Date: | 2022-01-20 |
| Deactivation Date: | |
| Deactivation Code: | |
| Reactivation Date: |
Provider Taxonomies
| Primary? | Code | Type | Classification | Specialization | Group |
|---|---|---|---|---|---|
| Yes | 261QM1300X | Ambulatory Health Care Facilities | Clinic/Center | Multi-Specialty | Group - Multi-Specialty |
| No | 101YA0400X | Behavioral Health & Social Service Providers | Counselor | Addiction (Substance Use Disorder) | Group - Multi-Specialty |
| No | 101YM0800X | Behavioral Health & Social Service Providers | Counselor | Mental Health | Group - Multi-Specialty |
| No | 103T00000X | Behavioral Health & Social Service Providers | Psychologist | Group - Multi-Specialty | |
| No | 1041C0700X | Behavioral Health & Social Service Providers | Social Worker | Clinical | Group - Multi-Specialty |
| No | 261Q00000X | Ambulatory Health Care Facilities | Clinic/Center | Group - Multi-Specialty | |
| No | 261QH0100X | Ambulatory Health Care Facilities | Clinic/Center | Health Service | |
| No | 261QM0801X | Ambulatory Health Care Facilities | Clinic/Center | Mental Health (Including Community Mental Health Center) | |
| No | 261QM0850X | Ambulatory Health Care Facilities | Clinic/Center | Adult Mental Health | |
| No | 261QM0855X | Ambulatory Health Care Facilities | Clinic/Center | Adolescent and Children Mental Health | |
| No | 363LC1500X | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner | Community Health | Group - Multi-Specialty |
| No | 363LP0808X | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner | Psychiatric/Mental Health | Group - Multi-Specialty |
