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General NPI Number Information
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NPI Number | 1902542624
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Entity Type | Organization
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Legal Business Name | A BEAUTIFUL MIND LLC
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Dates
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Enumeration Date | 05/05/2022
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Last Update Date | 05/05/2022
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Provider Practice Location Address
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Address Line | 1319 WOODBRIDGE STATION WAY STE 101
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City | EDGEWOOD
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State | MD
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Zip | 21040-3852
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Country | US
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Telephone | 443-961-7560
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Fax |
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Provider Business Mailing Address
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Address Line | 1802 EUTAW PL
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City | BALTIMORE
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State | MD
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Zip | 21217-3805
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Country | US
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Telephone | 443-801-3134
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Fax |
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Authorized Official
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Title or Position | OWNER/OPERATOR
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Name | CAMILLE G. MATTHEWS
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Credential |
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Telephone | 410-728-3737
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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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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