NPIMap

Individual provider Active NPI

Eathell Bernice Lewis

  • Mental Health Clinic/Center (Including Community Mental Health Center)
  • Randallstown, MD
National Provider Identifier
1043970510
Registry record updated Mar 7, 2022
On this page

Key facts

NPPES NPI Registry
Primary specialty
Mental Health Clinic/Center (Including Community Mental Health Center)Taxonomy code 261QM0801X
License
21011733 Issued in NU
Practice address
9331 Liberty Rd Suite 2C
Randallstown, MD 21133-3525
Phone
(443) 414-9699
NPI assigned
Dec 27, 2021
Last updated
Mar 7, 2022By the provider in NPPES
Sex
Female
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Mar 7, 2022

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 5

Specialty (taxonomy)CodeLicenseStatePrimary
Mental Health Clinic/Center (Including Community Mental Health Center) 261QM0801X 211011733 MD
Mental Health Clinic/Center (Including Community Mental Health Center) 261QM0801X 21011733 NU Primary
Counselor 101Y00000X NU
Addiction (Substance Use Disorder) Counselor 101YA0400X MD
Mental Health Counselor 101YM0800X NU

Addresses

Primary practice location

9331 Liberty Rd Suite 2C
Randallstown, MD 21133-3525

Mailing address

3812 Sandy Hook Road 3812 Sand
Randallstown, MD 21133
Phone (443) 414-9699

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Not listed in the public Medicare enrollment file

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Not enrolled

State licenses

LicenseStateTypeSpecialty
211011733MDMDMental Health Clinic/Center (Including Community Mental Health Center)

Practice roles

OrganizationSpecialtyStatusNew patients
Believing N Daily Journeys LLC Mental Health (Including Community Mental Health Center) CurrentSince Jan 2, 2022 Accepting new patients

Locations

9331 Liberty Rd
Ste 2C
Randallstown, MD 21133
Phone (443) 414-9699

Organizations & group practices 1

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1640563200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1646611200000",
    "number": "1043970510",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3812 SANDY HOOK ROAD 3812 SAND",
            "city": "RANDALLSTOWN",
            "state": "MD",
            "postal_code": "21133",
            "telephone_number": "443-414-9699",
            "fax_number": "443-279-6802"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "9331 LIBERTY RD SUITE 2C",
            "city": "RANDALLSTOWN",
            "state": "MD",
            "postal_code": "211333525",
            "telephone_number": "443-414-9699"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "LEWIS",
        "first_name": "EATHELL",
        "middle_name": "BERNICE",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2021-12-27",
        "last_updated": "2022-03-07",
        "certification_date": "2022-03-02",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "261QM0801X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Mental Health (Including Community Mental Health Center)",
            "state": "MD",
            "license": "211011733",
            "primary": false
        },
        {
            "code": "261QM0801X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Mental Health (Including Community Mental Health Center)",
            "state": "NU",
            "license": "21011733",
            "primary": true
        },
        {
            "code": "101Y00000X",
            "taxonomy_group": "",
            "desc": "Counselor",
            "state": "NU",
            "license": null,
            "primary": false
        },
        {
            "code": "101YA0400X",
            "taxonomy_group": "",
            "desc": "Counselor, Addiction (Substance Use Disorder)",
            "state": "MD",
            "license": null,
            "primary": false
        },
        {
            "code": "101YM0800X",
            "taxonomy_group": "",
            "desc": "Counselor, Mental Health",
            "state": "NU",
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Randallstown, MD

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 7, 2022; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.