NPIMap

Organization Active NPI

Mimo Backfin Blues

Doing business as Resilience Academy

  • Mental Health Counselor
  • Edgewood, MD
National Provider Identifier
1437027315
Registry record updated Oct 23, 2025
On this page

Key facts

NPPES NPI Registry
Primary specialty
Mental Health CounselorTaxonomy code 101YM0800X
Legal business name
MIMO BACKFIN BLUES
Doing business as
Resilience Academy
Practice address
500 Edgewood Rd Ste 202
Edgewood, MD 21040-2734
Phone
(443) 967-4656
Fax
(443) 449-7573
NPI assigned
Oct 23, 2025
Last updated
Oct 23, 2025By the provider in NPPES
Organization subpart
Yes
Parent organization
RESILIENCE ACADEMYAs reported in NPPES

NPPES NPI Registry

Updated by the provider on Oct 23, 2025

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

Authorized official

Name
Lula Moultrie Heatley, MSW, MRC, LCSW-CNPI 1164702098
Title
Therapist
Phone
(240) 273-8062

Authorized official NPPES reports the official by name only. The link goes to the one practitioner with that name whose NPPES practice address or phone number is this organization’s.

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Mental Health Counselor 101YM0800X NU Primary

Addresses

Primary practice location

500 Edgewood Rd Ste 202
Edgewood, MD 21040-2734

Mailing address

500 Edgewood Rd Ste 202
Edgewood, MD 21040-2734
Phone (443) 967-4656

Other names 1

  • Resilience Academy Doing business as

National Provider Directory

National Provider Directory
Tax ID family
Mimo Backfin Blues2 organizations share this tax ID, including this one
Part of
Mimo Backfin Blues

Other organizations with this tax ID 1

Organizations that report the same tax identification number in the National Provider Directory.

Locations

500 Edgewood Rd
Ste 202
Edgewood, MD 21040
Phone (443) 967-4656

Practitioners & affiliated clinicians

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

NPI Registry JSON

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

{
    "created_epoch": "1761177600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1761177600000",
    "number": "1437027315",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "500 EDGEWOOD RD STE 202",
            "city": "EDGEWOOD",
            "state": "MD",
            "postal_code": "210402734",
            "telephone_number": "443-967-4656",
            "fax_number": "443-449-7573"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "500 EDGEWOOD RD STE 202",
            "city": "EDGEWOOD",
            "state": "MD",
            "postal_code": "210402734",
            "telephone_number": "443-967-4656",
            "fax_number": "443-449-7573"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "MIMO BACKFIN BLUES",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "RESILIENCE ACADEMY",
        "enumeration_date": "2025-10-23",
        "last_updated": "2025-10-23",
        "certification_date": "2025-10-23",
        "status": "A",
        "authorized_official_last_name": "HEATLEY",
        "authorized_official_first_name": "LULA",
        "authorized_official_middle_name": "MOULTRIE",
        "authorized_official_title_or_position": "THERAPIST",
        "authorized_official_telephone_number": "240-273-8062",
        "authorized_official_credential": "MSW, MRC, LCSW-C"
    },
    "taxonomies": [
        {
            "code": "101YM0800X",
            "taxonomy_group": "",
            "desc": "Counselor, Mental Health",
            "state": "NU",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Resilience Academy",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Edgewood, MD

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 23, 2025; 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.