Provider Demographics
NPI:1184391344
Name:MIND BODY WELLNESS
Entity type:Organization
Organization Name:MIND BODY WELLNESS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:THERAPIST
Authorized Official - Prefix:
Authorized Official - First Name:NICOLE
Authorized Official - Middle Name:
Authorized Official - Last Name:SPARROW
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:240-899-2319
Mailing Address - Street 1:PO BOX 234
Mailing Address - Street 2:
Mailing Address - City:FREDERICK
Mailing Address - State:MD
Mailing Address - Zip Code:21705-0234
Mailing Address - Country:US
Mailing Address - Phone:240-899-2319
Mailing Address - Fax:410-970-3012
Practice Address - Street 1:1205 ROCK HILL DR
Practice Address - Street 2:
Practice Address - City:FREDERICK
Practice Address - State:MD
Practice Address - Zip Code:21703-8428
Practice Address - Country:US
Practice Address - Phone:443-574-4259
Practice Address - Fax:410-970-3012
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-08-25
Last Update Date:2023-08-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health