NPIMap

Organization Active NPI

Intentional Healing Space

  • Clinical Social Worker
  • Windsor Mill, MD
National Provider Identifier
1972989150
Registry record updated Aug 10, 2015
On this page

Key facts

NPPES NPI Registry
Primary specialty
Clinical Social WorkerTaxonomy code 1041C0700X
License
14857 Issued in MD
Legal business name
INTENTIONAL HEALING SPACE
Practice address
8517 Greens LN
Windsor Mill, MD 21244-1124
Phone
(410) 733-2055
NPI assigned
Aug 10, 2015
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Aug 10, 2015

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

Authorized official

Name
Jeremy P Darden
Title
Owner
Phone
(410) 733-2055

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Clinical Social WorkerGroup: 193200000X MULTI-SPECIALTY GROUP 1041C0700X 14857 MD Primary

Addresses

Primary practice location

8517 Greens LN
Windsor Mill, MD 21244-1124

Mailing address

8517 Greens LN
Windsor Mill, MD 21244-1124
Phone (410) 733-2055

National Provider Directory

National Provider Directory

NPI Registry JSON

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

{
    "created_epoch": "1439164800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1439164800000",
    "number": "1972989150",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "8517 GREENS LN",
            "city": "WINDSOR MILL",
            "state": "MD",
            "postal_code": "212441124",
            "telephone_number": "410-733-2055"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "8517 GREENS LN",
            "city": "WINDSOR MILL",
            "state": "MD",
            "postal_code": "212441124",
            "telephone_number": "410-733-2055"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "INTENTIONAL HEALING SPACE",
        "organizational_subpart": "NO",
        "enumeration_date": "2015-08-10",
        "last_updated": "2015-08-10",
        "status": "A",
        "authorized_official_last_name": "DARDEN",
        "authorized_official_first_name": "JEREMY",
        "authorized_official_middle_name": "P",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "410-733-2055"
    },
    "taxonomies": [
        {
            "code": "1041C0700X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Social Worker, Clinical",
            "state": "MD",
            "license": "14857",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Windsor Mill, MD

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 10, 2015; 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.