Provider Demographics
NPI:1609464379
Name:HEALING MIND WELLNESS
Entity Type:Organization
Organization Name:HEALING MIND WELLNESS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MEDICAL DIRECTOE
Authorized Official - Prefix:
Authorized Official - First Name:TYWANNA
Authorized Official - Middle Name:D
Authorized Official - Last Name:HAMILTON
Authorized Official - Suffix:
Authorized Official - Credentials:CRNP
Authorized Official - Phone:410-452-4325
Mailing Address - Street 1:124 SLADE AVE STE 101
Mailing Address - Street 2:
Mailing Address - City:PIKESVILLE
Mailing Address - State:MD
Mailing Address - Zip Code:21208-4900
Mailing Address - Country:US
Mailing Address - Phone:410-452-4325
Mailing Address - Fax:443-548-2800
Practice Address - Street 1:124 SLADE AVE STE 101
Practice Address - Street 2:
Practice Address - City:PIKESVILLE
Practice Address - State:MD
Practice Address - Zip Code:21208-4900
Practice Address - Country:US
Practice Address - Phone:410-452-4325
Practice Address - Fax:443-548-2800
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-01-07
Last Update Date:2021-03-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes261QM0801XAmbulatory Health Care FacilitiesClinic/CenterMental Health (Including Community Mental Health Center)Group - Single Specialty
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Single Specialty
No363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental HealthGroup - Single Specialty