Provider Demographics
NPI:1144838889
Name:MB THERAPEUTIC CENTER, LLC
Entity type:Organization
Organization Name:MB THERAPEUTIC CENTER, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:FOUNDER AND CEO
Authorized Official - Prefix:
Authorized Official - First Name:ROLANDA
Authorized Official - Middle Name:
Authorized Official - Last Name:GABRIEL
Authorized Official - Suffix:
Authorized Official - Credentials:LCPC
Authorized Official - Phone:704-340-2027
Mailing Address - Street 1:6614 ACCRINGTON CT
Mailing Address - Street 2:
Mailing Address - City:CHARLOTTE
Mailing Address - State:NC
Mailing Address - Zip Code:28227-1021
Mailing Address - Country:US
Mailing Address - Phone:704-340-2027
Mailing Address - Fax:
Practice Address - Street 1:218 E LEXINGTON ST STE 700
Practice Address - Street 2:
Practice Address - City:BALTIMORE
Practice Address - State:MD
Practice Address - Zip Code:21202-3518
Practice Address - Country:US
Practice Address - Phone:704-340-2027
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-07-20
Last Update Date:2020-07-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessionalGroup - Single Specialty