Provider Demographics
NPI:1457381618
Name:MIND BODY AND BALANCE
Entity Type:Organization
Organization Name:MIND BODY AND BALANCE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MS
Authorized Official - First Name:CHRISTINE
Authorized Official - Middle Name:L
Authorized Official - Last Name:LEORE
Authorized Official - Suffix:
Authorized Official - Credentials:LCPC LCADC MA
Authorized Official - Phone:410-526-5387
Mailing Address - Street 1:324 MAIN STREET
Mailing Address - Street 2:2ND FL
Mailing Address - City:REISTERSTOWN
Mailing Address - State:MD
Mailing Address - Zip Code:21136
Mailing Address - Country:US
Mailing Address - Phone:410-526-5387
Mailing Address - Fax:410-526-9834
Practice Address - Street 1:324 MAIN STREET
Practice Address - Street 2:2ND FL
Practice Address - City:REISTERSTOWN
Practice Address - State:MD
Practice Address - Zip Code:21136
Practice Address - Country:US
Practice Address - Phone:410-526-5387
Practice Address - Fax:410-526-9834
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-04
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDLC0033101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Single Specialty