Provider Demographics
NPI:1104251347
Name:HER MIND HER BODY CLINICAL ASSOCIATES
Entity type:Organization
Organization Name:HER MIND HER BODY CLINICAL ASSOCIATES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MS
Authorized Official - First Name:LACHRISIA
Authorized Official - Middle Name:LORRAINE
Authorized Official - Last Name:MATTHEWS
Authorized Official - Suffix:
Authorized Official - Credentials:LCPC, LPC
Authorized Official - Phone:202-250-4393
Mailing Address - Street 1:9332 ANNAPOLIS RD STE 304
Mailing Address - Street 2:
Mailing Address - City:LANHAM
Mailing Address - State:MD
Mailing Address - Zip Code:20706-3168
Mailing Address - Country:US
Mailing Address - Phone:202-250-4393
Mailing Address - Fax:
Practice Address - Street 1:2601 N ROLLING RD STE 105
Practice Address - Street 2:
Practice Address - City:BALTIMORE
Practice Address - State:MD
Practice Address - Zip Code:21244-1988
Practice Address - Country:US
Practice Address - Phone:202-250-4393
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-09-06
Last Update Date:2013-09-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDLC4547172V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes172V00000XOther Service ProvidersCommunity Health WorkerGroup - Multi-Specialty