Provider Demographics
NPI:1003264243
Name:MIND OVER MATTER HEALTH SERVICES
Entity Type:Organization
Organization Name:MIND OVER MATTER HEALTH SERVICES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:ASIA
Authorized Official - Middle Name:MARIA
Authorized Official - Last Name:AL-MATEEN
Authorized Official - Suffix:
Authorized Official - Credentials:LCPC, MAC, ACS
Authorized Official - Phone:410-982-1353
Mailing Address - Street 1:7700 OLD BRANCH AVE
Mailing Address - Street 2:B204
Mailing Address - City:CLINTON
Mailing Address - State:MD
Mailing Address - Zip Code:20735-1628
Mailing Address - Country:US
Mailing Address - Phone:301-868-0849
Mailing Address - Fax:
Practice Address - Street 1:7700 OLD BRANCH AVE
Practice Address - Street 2:B204
Practice Address - City:CLINTON
Practice Address - State:MD
Practice Address - Zip Code:20735-1628
Practice Address - Country:US
Practice Address - Phone:301-868-0849
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-05-27
Last Update Date:2016-05-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD577200101Medicaid