MARYLAND WELLNESS LLC NPI 1003479668

NPI Information

NPI: 1003479668
Provider Name: MARYLAND WELLNESS LLC
Classification: Clinic/Center - 261QM0801X
Entity Type: Organization

Specialization: Mental Health (Including Community Mental Health Center)

Address:
4128 HAYWARD AVE # W
BALTIMORE, MD
ZIP 21215
Phone: (410) 994-6491
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MARYLAND WELLNESS LLC is a mental health (including community mental health center) clinic center in Baltimore, MD. MARYLAND WELLNESS LLC NPI is 1003479668. The provider is registered as an organization entity type and is a multiple single specialty group.

The provider's business location address is:

4128 HAYWARD AVE # W
BALTIMORE, MD
ZIP 21215-340
Phone: (410) 994-6491

The provider's authorized official is Casey Wu .
The authorized official title is Director and has the following contact phone number (214) 659-1503.

The enumeration date for this NPI number is 4/19/2019 and was last updated on 3/7/2023.

Taxonomy Codes

The NPI record includes the healthcare provider taxonomy classification, state license number and state of licensure. The following information regarding the scope of practice of this provider is available:

No.	Taxonomy Code	Taxonomy Clasification	Taxonomy Specialization	Primary
1	103TP2701X	Psychologist	Group Psychotherapy	No
2	251B00000X	Case Management		No
3	261QR0405X	Clinic/Center	Rehabilitation, Substance Use Disorder	No
4	261QM0801X	Clinic/Center	Mental Health (Including Community Mental Health Center)	Yes

Other Identifiers

The following information regarding additional identifiers associated to this NPI record includes the other identifier number, identifier type, identifier state and issuer.

No.	Other Provider Identifier	Other Provider Identifier Type	Other Provider Identifier State	Other Provider Identifier Issuer
1	220412460	OTHER	MARYLAND	MARYLAND BEHAVIORAL HEALTH ADMINISTRATION
2	220412463	OTHER	MARYLAND	MARYLAND BEHAVIORAL HEALTH ADMINISTRATION
3	220412462	OTHER	MARYLAND	MARYLAND BEHAVIORAL HEALTH ADMINISTRATION
4	907713800	MEDICAID	MARYLAND
5	220412461	OTHER	MARYLAND	MARYLAND BEHAVIORAL HEALTH ADMINISTRATION
6	220412464	OTHER	MARYLAND	MARYLAND BEHAVIORAL HEALTH ADMINISTRATION

What is NPI?

NPI stands for National Provider Identifier. The NPI is a 10-digit identification number that is completely unique. The NPI number by itself does not contain any identifiable information such as a provider’s speciality or location. The NPI is assigned to individuals or organizacions for their lifespan and it is independent of key provider information type updates like a change of practices, location or speciality.

This page was last updated on: 4/28/2024

NPI Synchronization or Removal

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