Provider Demographics
NPI:1972290575
Name:MINDSPRING PSYCHIATRY AND WELLNESS
Entity Type:Organization
Organization Name:MINDSPRING PSYCHIATRY AND WELLNESS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:MR
Authorized Official - First Name:CHRISTOPHER
Authorized Official - Middle Name:GABRIEL
Authorized Official - Last Name:BENNETT
Authorized Official - Suffix:
Authorized Official - Credentials:MSN, CRNP-PMH
Authorized Official - Phone:865-804-4067
Mailing Address - Street 1:18348 SPARK DR UNIT 201
Mailing Address - Street 2:
Mailing Address - City:HAGERSTOWN
Mailing Address - State:MD
Mailing Address - Zip Code:21740-2086
Mailing Address - Country:US
Mailing Address - Phone:865-804-4067
Mailing Address - Fax:
Practice Address - Street 1:1190 MOUNT AETNA RD
Practice Address - Street 2:
Practice Address - City:HAGERSTOWN
Practice Address - State:MD
Practice Address - Zip Code:21740-6833
Practice Address - Country:US
Practice Address - Phone:240-222-5996
Practice Address - Fax:240-414-8638
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-04-24
Last Update Date:2023-04-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatryGroup - Single Specialty