Provider Demographics
NPI:1053902502
Name:REJUVENATED MINDS THERAPUTIC SERVICES LLC
Entity type:Organization
Organization Name:REJUVENATED MINDS THERAPUTIC SERVICES LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/ CEO
Authorized Official - Prefix:MRS
Authorized Official - First Name:SHAWNESSA
Authorized Official - Middle Name:MILLICENT
Authorized Official - Last Name:DEVONISH
Authorized Official - Suffix:
Authorized Official - Credentials:LGPC, NCC
Authorized Official - Phone:301-219-6955
Mailing Address - Street 1:137 NATIONAL PLZ STE 300
Mailing Address - Street 2:
Mailing Address - City:OXON HILL
Mailing Address - State:MD
Mailing Address - Zip Code:20745-1153
Mailing Address - Country:US
Mailing Address - Phone:301-219-6955
Mailing Address - Fax:
Practice Address - Street 1:137 NATIONAL PLZ STE 300
Practice Address - Street 2:
Practice Address - City:OXON HILL
Practice Address - State:MD
Practice Address - Zip Code:20745-1153
Practice Address - Country:US
Practice Address - Phone:301-219-6955
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-01-28
Last Update Date:2021-02-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0801XAmbulatory Health Care FacilitiesClinic/CenterMental Health (Including Community Mental Health Center)
No261QM0850XAmbulatory Health Care FacilitiesClinic/CenterAdult Mental Health