Organization
MIND OVER MATTER HEALTH SERVICES, INC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
ASIA M JOHNSON LCPC, LCAD-AS (CEO)
(410) 982-1353
Entity
Organization
Contact information
Practice address
5406 WHITLOCK RD, BALTIMORE, MD 21229-1020
(410) 777-8522
Mailing address
10016 MARRIOTTSVILLE RD, RANDALLSTOWN, MD 21133-1502
Taxonomy
Speciality
Code
Description
License number
State
101YA0400X
Addiction (Substance Use Disorder) Counselor
—
—
251B00000X
Case Management Agency
—
—
251C00000X
Developmentally Disabled Services Day Training Agency
—
—
251S00000X
Community/Behavioral Health Agency
Primary
—
—
261QR0405X
Substance Use Disorder Rehabilitation Clinic/Center
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
577200101
—
MD
Enumeration date
03/19/2022
Last updated
03/19/2022
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