Organization
MINDFUL CHI BEHAVIORAL HEALTH, INC.
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. SUZZETTE VAN-LARE DMSC (OWNER)
(678) 907-3060
Entity
Organization
Contact information
Practice address
5457 TWIN KNOLLS RD, STE 300 #1082, COLUMBIA, MD 21045-3296
(240) 608-2744
Mailing address
5457 TWIN KNOLLS RD, STE 300 #1082, COLUMBIA, MD 21045-3296
Taxonomy
Speciality
Code
Description
License number
State
207R00000X
Internal Medicine Physician
—
—
2084P0800X
Psychiatry Physician
Primary
—
—
363A00000X
Physician Assistant
—
—
Other
Enumeration date
03/20/2024
Last updated
03/20/2024
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