Healthcare Provider Details

I. General information

NPI: 1316546310
Provider Name (Legal Business Name): I-MATTER, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/21/2020
Last Update Date: 04/17/2023
Certification Date: 04/05/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8511 LOCH RAVEN BLVD
BALTIMORE MD
21286-2302
US

IV. Provider business mailing address

8511 LOCH RAVEN BLVD UPPER LEVEL (A)
BALTIMORE MD
21286-2302
US

V. Phone/Fax

Practice location:
  • Phone: 410-497-5840
  • Fax: 410-497-5797
Mailing address:
  • Phone: 410-497-5840
  • Fax: 410-497-5797

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QM0801X
TaxonomyMental Health Clinic/Center (Including Community Mental Health Center)
License Number
License Number StateNULL
# 2
Primary TaxonomyN
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number StateNULL

VIII. Authorized Official

Name: ALYSIA BARBER
Title or Position: CEO/MEDICAL DIRECTOR
Credential:
Phone: 305-491-7216