NPIMap

Organization Active NPI

Charm City Mental Health Practice, LLC

  • Mental Health Clinic/Center (Including Community Mental Health Center)
  • Towson, MD
National Provider Identifier
1184093221
Registry record updated Oct 24, 2020
On this page

Key facts

NPPES NPI Registry
Primary specialty
Mental Health Clinic/Center (Including Community Mental Health Center)Taxonomy code 261QM0801X
License
LC6058 Issued in MD
Legal business name
CHARM CITY MENTAL HEALTH PRACTICE, LLC
Practice address
100 West Rd Ste 112
Towson, MD 21204-2358
Phone
(443) 927-6535
Fax
(410) 828-0300
NPI assigned
Sep 18, 2015
Last updated
Oct 24, 2020By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Oct 24, 2020

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name
Rachel Courtney Matyja, LCPCNPI 1962888008
Title
Owner/Resident Agent
Phone
(443) 927-6535

Authorized official NPPES reports the official by name only. The link goes to the one practitioner connected to this organization with that name.

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Mental Health Clinic/Center (Including Community Mental Health Center) 261QM0801X LC6058 MD Primary

Addresses

Primary practice location

100 West Rd Ste 112
Towson, MD 21204-2358

Mailing address

100 West Rd Ste 112
Towson, MD 21204-2358
Phone (443) 927-6535

Other identifiers 1

IdentifierTypeStateIssuer
LC6058OtherMDLICENSED CLINICAL PROFESSIONAL COUNSELOR

National Provider Directory

National Provider Directory

Locations

100 West Rd
Ste 112
Towson, MD 21204
Phone (410) 321-4900

Practitioners & affiliated clinicians

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1442534400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1603497600000",
    "number": "1184093221",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "100 WEST RD STE 112",
            "city": "TOWSON",
            "state": "MD",
            "postal_code": "212042358",
            "telephone_number": "443-927-6535",
            "fax_number": "410-828-0300"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "100 WEST RD STE 112",
            "city": "TOWSON",
            "state": "MD",
            "postal_code": "212042358",
            "telephone_number": "443-927-6535",
            "fax_number": "410-828-0300"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "CHARM CITY MENTAL HEALTH PRACTICE, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2015-09-18",
        "last_updated": "2020-10-24",
        "certification_date": "2020-10-24",
        "status": "A",
        "authorized_official_last_name": "MATYJA",
        "authorized_official_first_name": "RACHEL",
        "authorized_official_middle_name": "COURTNEY",
        "authorized_official_title_or_position": "OWNER/RESIDENT AGENT",
        "authorized_official_telephone_number": "443-927-6535",
        "authorized_official_credential": "LCPC"
    },
    "taxonomies": [
        {
            "code": "261QM0801X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Mental Health (Including Community Mental Health Center)",
            "state": "MD",
            "license": "LC6058",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "LICENSED CLINICAL PROFESSIONAL COUNSELOR",
            "identifier": "LC6058",
            "state": "MD"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Towson, MD

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 24, 2020; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.