Provider Demographics
NPI:1407576853
Name:N.E. BEAUTIFUL MIND, LLC
Entity Type:Organization
Organization Name:N.E. BEAUTIFUL MIND, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/CLINICAL THERAPIST
Authorized Official - Prefix:MRS
Authorized Official - First Name:JERNAE
Authorized Official - Middle Name:
Authorized Official - Last Name:DICKENS
Authorized Official - Suffix:
Authorized Official - Credentials:LPC, NCC
Authorized Official - Phone:301-640-0300
Mailing Address - Street 1:3210 WINTERBOURNE DR
Mailing Address - Street 2:
Mailing Address - City:UPPER MARLBORO
Mailing Address - State:MD
Mailing Address - Zip Code:20774-9084
Mailing Address - Country:US
Mailing Address - Phone:202-246-8323
Mailing Address - Fax:
Practice Address - Street 1:1050 30TH ST NW # 107
Practice Address - Street 2:
Practice Address - City:WASHINGTON
Practice Address - State:DC
Practice Address - Zip Code:20007-3822
Practice Address - Country:US
Practice Address - Phone:301-640-0300
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-08-29
Last Update Date:2022-11-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0855XAmbulatory Health Care FacilitiesClinic/CenterAdolescent and Children Mental Health
No261QM0850XAmbulatory Health Care FacilitiesClinic/CenterAdult Mental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
DCDC2022Medicaid
BCBS2022OtherBLUECROSS & BLUE SHEILD
UHC2022OtherUNITED HEALTHCARE