Healthcare Provider Details

I. General information

NPI: 1629353719
Provider Name (Legal Business Name): TOTAL WELLNESS
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/20/2011
Last Update Date: 10/20/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

723 S CHARLES ST SUITE 103
BALTIMORE MD
21230-3811
US

IV. Provider business mailing address

723 S CHARLES ST SUITE 103
BALTIMORE MD
21230-3811
US

V. Phone/Fax

Practice location:
  • Phone: 410-605-0180
  • Fax: 410-605-0181
Mailing address:
  • Phone: 410-605-0180
  • Fax: 410-605-0181

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101Y00000X
TaxonomyCounselor
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code104100000X
TaxonomySocial Worker
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License Number
License Number State
# 4
Primary TaxonomyN
Taxonomy Code136A00000X
TaxonomyRegistered Dietetic Technician
License Number
License Number State

VIII. Authorized Official

Name: DR. VARSHA KUNNIRICKAL
Title or Position: DIRECTOR
Credential: MD
Phone: 240-475-6817