Provider Demographics
NPI:1508297292
Name:HER MIND HER BODY WELLNESS PROGRAM
Entity Type:Organization
Organization Name:HER MIND HER BODY WELLNESS PROGRAM
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:FOUNDER AND CEO
Authorized Official - Prefix:
Authorized Official - First Name:LACHRISIA
Authorized Official - Middle Name:LORRAINE
Authorized Official - Last Name:MATTHEWS
Authorized Official - Suffix:
Authorized Official - Credentials:LCPC, LPC
Authorized Official - Phone:202-250-4393
Mailing Address - Street 1:10711 RED RUN BLVD STE 112
Mailing Address - Street 2:
Mailing Address - City:OWINGS MILLS
Mailing Address - State:MD
Mailing Address - Zip Code:21117-5138
Mailing Address - Country:US
Mailing Address - Phone:410-298-4642
Mailing Address - Fax:
Practice Address - Street 1:10711 RED RUN BLVD STE 112
Practice Address - Street 2:
Practice Address - City:OWINGS MILLS
Practice Address - State:MD
Practice Address - Zip Code:21117-5138
Practice Address - Country:US
Practice Address - Phone:410-298-4642
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-12-05
Last Update Date:2024-04-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD251S00000X
261QM0801X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health
No261QM0801XAmbulatory Health Care FacilitiesClinic/CenterMental Health (Including Community Mental Health Center)