# MIMO BACKFIN BLUES

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- **Entity:** Organization
- **Status:** Active
- **Parent organization:** RESILIENCE ACADEMY
- **Other names:** Resilience Academy
- **Organization subpart:** Yes

## Provider details

- **NPI number:** 1437027315
- **Legal business name:** RESILIENCE ACADEMY
- **Authorized official:** LULA MOULTRIE HEATLEY MSW, MRC, LCSW-C (THERAPIST)
- **Authorized official phone:** (240) 273-8062

## Contact information

- **Practice address:** 500 EDGEWOOD RD STE 202, EDGEWOOD, MD 21040-2734
- **Practice address phone:** (443) 967-4656
- **Practice address fax:** (443) 449-7573
- **Mailing address:** 500 EDGEWOOD RD STE 202, EDGEWOOD, MD 21040-2734
- **Mailing address phone:** (443) 967-4656
- **Mailing address fax:** (443) 449-7573

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 101YM0800X | Mental Health Counselor | — | NULL | Yes |
| 101YM0800X | Mental Health Counselor | — | — | Yes |

## Other

- **Enumeration date:** 10/23/2025
- **Last updated:** 10/23/2025