NPIMap

Organization Active NPI

Light and Mind Wellness LLC

  • Psychiatric/Mental Health Nurse Practitioner
  • Easton, MD
National Provider Identifier
1609449677
Registry record updated Jan 25, 2025
On this page

Key facts

NPPES NPI Registry
Primary specialty
Psychiatric/Mental Health Nurse PractitionerTaxonomy code 363LP0808X
Legal business name
LIGHT AND MIND WELLNESS LLC
Practice address
8707 Commerce Dr Ste E
Easton, MD 21601-6910
Phone
(410) 855-4664
Fax
(855) 461-3481
NPI assigned
Jul 19, 2021
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jan 25, 2025

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

Authorized official

Name
Aisha Hassan-Davis, CNS,PMH-NP, APRNNPI 1053951004
Title
Owner/Provider
Phone
(443) 239-2033

Authorized official NPPES reports the official by name only. The link goes to the one practitioner connected to this organization with that name.

Specialties & licenses 5

Specialty (taxonomy)CodeLicenseStatePrimary
Mental Health Clinic/Center (Including Community Mental Health Center) 261QM0801X
Adult Mental Health Clinic/Center 261QM0850X
Adolescent and Children Mental Health Clinic/Center 261QM0855X
Nurse PractitionerGroup: 193200000X MULTI-SPECIALTY GROUP 363L00000X
Psychiatric/Mental Health Nurse PractitionerGroup: 193200000X MULTI-SPECIALTY GROUP 363LP0808X Primary

Addresses

Primary practice location

8707 Commerce Dr Ste E
Easton, MD 21601-6910

Mailing address

8707 Commerce Dr Ste E
Easton, MD 21601-6910
Phone (443) 239-2033

Other practice location 1

811 N Broad St Ste 225A
Middletown, DE 19709-1173
Phone (443) 239-2033

Other identifiers 2

IdentifierTypeStateIssuer
250696270MedicaidDE
206453701MedicaidMD

Other names 1

  • Light And Mind WELLNESS LLC Other name

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in MD, DE2 enrollments

Enrollment records 2

Enrollment IDStateProvider typePAC IDDetails
O20210924001114 MD Part B Supplier - Clinic/Group Practice 1052718673 Receives reassigned benefits from 3 practitioners
Practice locations: Easton, MD
O20240312001962 DE Part B Supplier - Clinic/Group Practice 1052718673 Receives reassigned benefits from 3 practitioners
Practice locations: Middletown, DE

National Provider Directory

National Provider Directory

Locations

811 N Broad St
Ste 225A
Middletown, DE 19709
Phone (301) 873-5066

811 N Broad St
Ste 225
Middletown, DE 19709
Phone (413) 464-5247

8707 Commerce Dr
Ste E
Easton, MD 21601
Phone (410) 855-4664

8603 Commerce Dr
Easton, MD 21601

9 S Harrison St
Easton, MD 21601
Phone (301) 830-8533

Practitioners & affiliated clinicians

Practitioners 4

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

NPI Registry JSON

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

{
    "created_epoch": "1626652800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1737763200000",
    "number": "1609449677",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "8707 COMMERCE DR STE E",
            "city": "EASTON",
            "state": "MD",
            "postal_code": "216016910",
            "telephone_number": "443-239-2033",
            "fax_number": "855-461-3481"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "8707 COMMERCE DR STE E",
            "city": "EASTON",
            "state": "MD",
            "postal_code": "216016910",
            "telephone_number": "410-855-4664",
            "fax_number": "855-461-3481"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "811 N Broad St Ste 225A",
            "address_purpose": "LOCATION",
            "city": "Middletown",
            "state": "DE",
            "postal_code": "197091173",
            "country_code": "US",
            "telephone_number": "443-239-2033",
            "fax_number": "855-461-3481",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "organization_name": "LIGHT AND MIND WELLNESS LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2021-07-19",
        "last_updated": "2025-01-25",
        "certification_date": "2025-01-25",
        "status": "A",
        "authorized_official_last_name": "HASSAN-DAVIS",
        "authorized_official_first_name": "AISHA",
        "authorized_official_title_or_position": "OWNER/PROVIDER",
        "authorized_official_telephone_number": "443-239-2033",
        "authorized_official_credential": "CNS,PMH-NP, APRN"
    },
    "taxonomies": [
        {
            "code": "261QM0801X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Mental Health (Including Community Mental Health Center)",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "261QM0850X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Adult Mental Health",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "261QM0855X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Adolescent and Children Mental Health",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "363L00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Nurse Practitioner",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "363LP0808X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Nurse Practitioner, Psychiatric/Mental Health",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "250696270",
            "state": "DE"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "206453701",
            "state": "MD"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Light And Mind WELLNESS LLC",
            "code": "5",
            "type": "Other Name"
        }
    ]
}

Other providers in Easton, MD

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 25, 2025; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.