Provider Demographics
NPI:1912344862
Name:ASIA AL-MATEEN LCPC ACS
Entity Type:Organization
Organization Name:ASIA AL-MATEEN LCPC ACS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:ASIA
Authorized Official - Middle Name:MARIA
Authorized Official - Last Name:AL-MATEEN
Authorized Official - Suffix:
Authorized Official - Credentials:LCPC
Authorized Official - Phone:410-982-1353
Mailing Address - Street 1:2909 FALLSTAFF RD
Mailing Address - Street 2:37
Mailing Address - City:BALTIMORE
Mailing Address - State:MD
Mailing Address - Zip Code:21209-3226
Mailing Address - Country:US
Mailing Address - Phone:410-982-1353
Mailing Address - Fax:443-766-1713
Practice Address - Street 1:515 N CHESTER ST
Practice Address - Street 2:B
Practice Address - City:BALTIMORE
Practice Address - State:MD
Practice Address - Zip Code:21205-2301
Practice Address - Country:US
Practice Address - Phone:410-982-1353
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-06-02
Last Update Date:2013-06-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD2133101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessionalGroup - Single Specialty