Healthcare Provider Details

I. General information

NPI: 1649473026
Provider Name (Legal Business Name): MPB GROUP INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/06/2007
Last Update Date: 07/29/2024
Certification Date: 07/29/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6440 DOBBIN RD STE D
COLUMBIA MD
21045
US

IV. Provider business mailing address

6440 DOBBIN RD STE D
COLUMBIA MD
21045-4770
US

V. Phone/Fax

Practice location:
  • Phone: 410-730-2385
  • Fax: 866-371-5933
Mailing address:
  • Phone: 410-730-2385
  • Fax: 866-371-5933

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251S00000X
TaxonomyCommunity/Behavioral Health Agency
License Number1769
License Number StateMD

VIII. Authorized Official

Name: DR. MAGALIE BREWER
Title or Position: CEO, COMPLIANCE DIRECTOR
Credential: LCPC
Phone: 410-730-2385