Provider Demographics
NPI:1518703883
Name:VILLAGE OF SOUND MIND
Entity type:Organization
Organization Name:VILLAGE OF SOUND MIND
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:LCSW-C
Authorized Official - Prefix:
Authorized Official - First Name:PHILICIA
Authorized Official - Middle Name:R
Authorized Official - Last Name:ROSS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:240-712-4106
Mailing Address - Street 1:3030 GREENMOUNT AVE
Mailing Address - Street 2:STE 300 BALTIMORE
Mailing Address - City:BALTIMORE
Mailing Address - State:MD
Mailing Address - Zip Code:21218
Mailing Address - Country:US
Mailing Address - Phone:240-712-4106
Mailing Address - Fax:
Practice Address - Street 1:3030 GREENMOUNT AVE
Practice Address - Street 2:STE 300 BALTIMORE
Practice Address - City:BALTIMORE
Practice Address - State:MD
Practice Address - Zip Code:21218
Practice Address - Country:US
Practice Address - Phone:240-712-4106
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-07-05
Last Update Date:2024-07-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Single Specialty