Healthcare Provider Details

I. General information

NPI: 1063244994
Provider Name (Legal Business Name): AMAZING WELLNESS CARE LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/19/2024
Last Update Date: 01/08/2026
Certification Date: 01/08/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2408 MINNESOTA AVE SE # NA
WASHINGTON DC
20020-5328
US

IV. Provider business mailing address

2408 MINNESOTA AVE SE # NA
WASHINGTON DC
20020-5328
US

V. Phone/Fax

Practice location:
  • Phone: 240-478-1969
  • Fax:
Mailing address:
  • Phone: 240-478-1969
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code261QM0801X
TaxonomyMental Health Clinic/Center (Including Community Mental Health Center)
License Number
License Number State

VIII. Authorized Official

Name: CHRISTOPHER ELONG
Title or Position: CEO
Credential: LLB
Phone: 240-478-1969