Organization
MIRROR MENTAL HEALTH
Active
Organization subpart
No
Provider details
NPI number
Authorized official
ANGIE BOULWARE (DIRECTOR, CREDENTIALING & CONTRACT)
(800) 288-3406
Entity
Organization
Contact information
Practice address
2110 PRIEST BRIDGE DR STE 1, CROFTON, MD 21114-2472
(443) 937-7089
(443) 292-4570
Mailing address
2110 PRIEST BRIDGE DR STE 1, CROFTON, MD 21114-2472
(443) 937-7089
(443) 292-4570
Taxonomy
Speciality
Code
Description
License number
State
103TC1900X
Counseling Psychologist
Primary
—
—
Other
Enumeration date
01/14/2019
Last updated
01/14/2019
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