Provider Demographics
NPI:1821673385
Name:A BEAUTIFUL MIND: COUNSELING & WELLNESS STUDIO
Entity Type:Organization
Organization Name:A BEAUTIFUL MIND: COUNSELING & WELLNESS STUDIO
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:MS
Authorized Official - First Name:ERICA
Authorized Official - Middle Name:DANYELLE
Authorized Official - Last Name:KELLY
Authorized Official - Suffix:
Authorized Official - Credentials:LCSW-C
Authorized Official - Phone:443-762-7537
Mailing Address - Street 1:1190 W NORTHERN PKWY APT 404
Mailing Address - Street 2:
Mailing Address - City:ROLAND PARK
Mailing Address - State:MD
Mailing Address - Zip Code:21210-1453
Mailing Address - Country:US
Mailing Address - Phone:443-762-7537
Mailing Address - Fax:
Practice Address - Street 1:326 SAINT PAUL ST STE 400A
Practice Address - Street 2:
Practice Address - City:BALTIMORE
Practice Address - State:MD
Practice Address - Zip Code:21202-2176
Practice Address - Country:US
Practice Address - Phone:443-762-7537
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-03-16
Last Update Date:2021-03-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0801XAmbulatory Health Care FacilitiesClinic/CenterMental Health (Including Community Mental Health Center)