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General NPI Number Information
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NPI Number | 1003565979
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Entity Type | Organization
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Legal Business Name | MIND OVER MATTER HEALTH SERVICES, INC
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Dates
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Enumeration Date | 03/19/2022
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Last Update Date | 03/19/2022
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Provider Practice Location Address
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Address Line | 10016 MARRIOTTSVILLE RD
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City | RANDALLSTOWN
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State | MD
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Zip | 21133-1502
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Country | US
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Telephone | 443-405-1095
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Fax |
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Provider Business Mailing Address
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Address Line | 10016 MARRIOTTSVILLE RD
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City | RANDALLSTOWN
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State | MD
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Zip | 21133-1502
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | PRACTITIONER/ADMINISTRATOR
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Name | ASIA JOHNSON
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Credential | LCPC
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Telephone | 410-982-1353
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 3245S0500X
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Taxonomy Name | Children's Substance Abuse Rehabilitation Facility
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 251B00000X
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Taxonomy Name | Case Management Agency
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License Number |
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License Number State |
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Taxonomy #3
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Taxonomy Code | 251C00000X
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Taxonomy Name | Developmentally Disabled Services Day Training Agency
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License Number |
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License Number State |
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Taxonomy #4
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Taxonomy Code | 261QC1500X
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Taxonomy Name | Community Health Clinic/Center
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License Number |
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License Number State |
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Taxonomy #5
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Taxonomy Code | 261QM0801X
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Taxonomy Name | Mental Health Clinic/Center (Including Community Mental Health Center)
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License Number |
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License Number State |
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Taxonomy #6
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Taxonomy Code | 261QM1300X
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Taxonomy Name | Multi-Specialty Clinic/Center
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License Number |
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License Number State |
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Taxonomy #7
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Taxonomy Code | 251S00000X
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Taxonomy Name | Community/Behavioral Health Agency
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License Number |
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License Number State |
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