Provider Demographics
NPI:1396168522
Name:MINDS IN MOTION CHILDREN'S CENTER, LLC
Entity type:Organization
Organization Name:MINDS IN MOTION CHILDREN'S CENTER, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CO-OWNER
Authorized Official - Prefix:MRS
Authorized Official - First Name:LATISHA
Authorized Official - Middle Name:JANNELL
Authorized Official - Last Name:GASAWAY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:301-977-9393
Mailing Address - Street 1:8041 CESSNA AVE
Mailing Address - Street 2:STE 232
Mailing Address - City:GAITHERSBURG
Mailing Address - State:MD
Mailing Address - Zip Code:20879-4169
Mailing Address - Country:US
Mailing Address - Phone:301-977-9393
Mailing Address - Fax:301-977-9394
Practice Address - Street 1:8041 CESSNA AVE
Practice Address - Street 2:STE 232
Practice Address - City:GAITHERSBURG
Practice Address - State:MD
Practice Address - Zip Code:20879-4169
Practice Address - Country:US
Practice Address - Phone:301-977-9393
Practice Address - Fax:301-977-9394
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-01-23
Last Update Date:2014-01-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
235Z00000X
MD158434252Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes252Y00000XAgenciesEarly Intervention Provider Agency
No235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language PathologistGroup - Single Specialty