Provider Demographics
NPI:1013593805
Name:BRAIN MATTERS THERAPY, PLLC
Entity Type:Organization
Organization Name:BRAIN MATTERS THERAPY, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:ANTONIA
Authorized Official - Middle Name:
Authorized Official - Last Name:PORTER
Authorized Official - Suffix:
Authorized Official - Credentials:LPC
Authorized Official - Phone:276-970-9747
Mailing Address - Street 1:546 VIRGINIA AVE
Mailing Address - Street 2:
Mailing Address - City:BLUEFIELD
Mailing Address - State:VA
Mailing Address - Zip Code:24605-1729
Mailing Address - Country:US
Mailing Address - Phone:276-970-9747
Mailing Address - Fax:
Practice Address - Street 1:546 VIRGINIA AVE
Practice Address - Street 2:
Practice Address - City:BLUEFIELD
Practice Address - State:VA
Practice Address - Zip Code:24605-1729
Practice Address - Country:US
Practice Address - Phone:276-970-9747
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:SUNSHINE COUNSELING CENTER, LLC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2021-03-22
Last Update Date:2021-03-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessionalGroup - Single Specialty