Healthcare Provider Details

I. General information

NPI: 1366170003
Provider Name (Legal Business Name): GREY MATTER COUNSELING & CONSULTING, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/10/2022
Last Update Date: 03/28/2024
Certification Date: 03/28/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

221 MAITLAND ST STE 200
BEL AIR MD
21014-3930
US

IV. Provider business mailing address

3 CANVAS PL
BEL AIR MD
21015-8613
US

V. Phone/Fax

Practice location:
  • Phone: 443-720-6008
  • Fax:
Mailing address:
  • Phone: 914-469-9073
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code261Q00000X
TaxonomyClinic/Center
License Number
License Number State

VIII. Authorized Official

Name: JOSE ROSADO
Title or Position: OWNER
Credential: LCPC, NCC, MBA
Phone: 443-720-6008