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General NPI Number Information
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NPI Number | 1144838889
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Entity Type | Organization
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Legal Business Name | MB THERAPEUTIC CENTER, LLC
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Dates
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Enumeration Date | 07/20/2020
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Last Update Date | 07/20/2020
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Provider Practice Location Address
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Address Line | 218 E LEXINGTON ST STE 700
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City | BALTIMORE
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State | MD
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Zip | 21202-3518
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Country | US
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Telephone | 704-340-2027
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Fax |
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Provider Business Mailing Address
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Address Line | 6614 ACCRINGTON CT
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City | CHARLOTTE
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State | NC
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Zip | 28227-1021
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Country | US
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Telephone | 704-340-2027
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Fax |
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Authorized Official
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Title or Position | FOUNDER AND CEO
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Name | ROLANDA GABRIEL
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Credential | LCPC
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Telephone | 704-340-2027
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 101YP2500X
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Taxonomy Name | Professional Counselor
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License Number |
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License Number State |
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