Healthcare Provider Details

I. General information

NPI: 1730017906
Provider Name (Legal Business Name): MATTIE LEE CHRISTIAN COUNSELING AND WELLNESS CENTER, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/09/2026
Last Update Date: 05/09/2026
Certification Date: 05/09/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7836 CANTER CT
SEVERN MD
21144-6801
US

IV. Provider business mailing address

4838 LONGVIEW RUN
DECATUR GA
30035-4099
US

V. Phone/Fax

Practice location:
  • Phone: 443-380-0148
  • Fax:
Mailing address:
  • Phone: 443-380-0148
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number State

VIII. Authorized Official

Name: CARMETTA PATRICE MAUPIN
Title or Position: CLINICAL DIRECTOR
Credential: EDD, LCPC
Phone: 443-380-0148