Provider Demographics
NPI:1881148559
Name:MIND MATTERS RESOURCE GROUP
Entity type:Organization
Organization Name:MIND MATTERS RESOURCE GROUP
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:MS
Authorized Official - First Name:LATASHA
Authorized Official - Middle Name:GENELL
Authorized Official - Last Name:ROLES
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:443-208-6156
Mailing Address - Street 1:4022 DUDLEY AVE
Mailing Address - Street 2:
Mailing Address - City:BALTIMORE
Mailing Address - State:MD
Mailing Address - Zip Code:21213-2139
Mailing Address - Country:US
Mailing Address - Phone:443-208-6156
Mailing Address - Fax:
Practice Address - Street 1:204 W SARATOGA ST
Practice Address - Street 2:
Practice Address - City:BALTIMORE
Practice Address - State:MD
Practice Address - Zip Code:21201-3511
Practice Address - Country:US
Practice Address - Phone:443-208-6156
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-08-10
Last Update Date:2016-08-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health