Provider Demographics
NPI:1619249984
Name:INNOVATING MINDS LLC
Entity Type:Organization
Organization Name:INNOVATING MINDS LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:SOCIAL WORKER
Authorized Official - Prefix:MS
Authorized Official - First Name:TORRI
Authorized Official - Middle Name:LYNN
Authorized Official - Last Name:MILLS-RAIKES
Authorized Official - Suffix:
Authorized Official - Credentials:LCSW-C
Authorized Official - Phone:443-891-4509
Mailing Address - Street 1:1506 BURNWOOD RD
Mailing Address - Street 2:
Mailing Address - City:BALTIMORE
Mailing Address - State:MD
Mailing Address - Zip Code:21239-3538
Mailing Address - Country:US
Mailing Address - Phone:443-891-4509
Mailing Address - Fax:
Practice Address - Street 1:1506 BURNWOOD RD
Practice Address - Street 2:
Practice Address - City:BALTIMORE
Practice Address - State:MD
Practice Address - Zip Code:21239-3538
Practice Address - Country:US
Practice Address - Phone:443-891-4509
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-02-02
Last Update Date:2012-10-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD13608251S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health