Organization
MIND OVER MATTER HEALTH SERVICES, INC
Active
Parent organization
ASIA JOHNSON
Other names
Asia Johnson LCPC
Organization subpart
Yes
Provider details
NPI number
Legal business name
ASIA JOHNSON
Authorized official
ASIA JOHNSON LCPC (PRACTITIONER/ADMINISTRATOR)
(410) 982-1353
Entity
Organization
Contact information
Practice address
10016 MARRIOTTSVILLE RD, RANDALLSTOWN, MD 21133-1502
(443) 405-1095
Mailing address
10016 MARRIOTTSVILLE RD, RANDALLSTOWN, MD 21133-1502
Taxonomy
Speciality
Code
Description
License number
State
251B00000X
Case Management Agency
—
—
251C00000X
Developmentally Disabled Services Day Training Agency
—
—
251S00000X
Community/Behavioral Health Agency
Primary
—
—
261QC1500X
Community Health Clinic/Center
—
—
261QM0801X
Mental Health Clinic/Center (Including Community Mental Health Center)
—
—
261QM1300X
Multi-Specialty Clinic/Center
—
—
3245S0500X
Children's Substance Abuse Rehabilitation Facility
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
300269100
—
MD
Enumeration date
03/19/2022
Last updated
03/19/2022
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