Provider Demographics
NPI:1558605733
Name:MIND & REASON ADVOCACY GROUP, LLC.
Entity Type:Organization
Organization Name:MIND & REASON ADVOCACY GROUP, LLC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CHIEF EXECUTIVE OFFICER
Authorized Official - Prefix:MR
Authorized Official - First Name:DAVIAN
Authorized Official - Middle Name:NIKEITH
Authorized Official - Last Name:ISOM
Authorized Official - Suffix:
Authorized Official - Credentials:MSW
Authorized Official - Phone:202-246-6781
Mailing Address - Street 1:3511 LESLIE AVE
Mailing Address - Street 2:
Mailing Address - City:TEMPLE HILLS
Mailing Address - State:MD
Mailing Address - Zip Code:20748-4633
Mailing Address - Country:US
Mailing Address - Phone:202-246-6781
Mailing Address - Fax:
Practice Address - Street 1:2806 POMEROY RD SE
Practice Address - Street 2:2808 POMEROY RD SE
Practice Address - City:WASHINGTON
Practice Address - State:DC
Practice Address - Zip Code:20020-5912
Practice Address - Country:US
Practice Address - Phone:202-246-6781
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-11-12
Last Update Date:2012-11-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes320800000XResidential Treatment FacilitiesCommunity Based Residential Treatment Facility, Mental Illness
No320600000XResidential Treatment FacilitiesResidential Treatment Facility, Intellectual and/or Developmental Disabilities
No320900000XResidential Treatment FacilitiesCommunity Based Residential Treatment Facility, Intellectual and/or Developmental Disabilities
No322D00000XResidential Treatment FacilitiesResidential Treatment Facility, Emotionally Disturbed Children
No323P00000XResidential Treatment FacilitiesPsychiatric Residential Treatment Facility