Healthcare Provider Details

I. General information

NPI: 1013486620
Provider Name (Legal Business Name): TNAT HOLISTIC WELLNESS CENTER
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/14/2018
Last Update Date: 11/14/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3221 BELAIR RD
BALTIMORE MD
21213-1242
US

IV. Provider business mailing address

1652 WINFORD RD
BALTIMORE MD
21239-3610
US

V. Phone/Fax

Practice location:
  • Phone: 443-333-2970
  • Fax:
Mailing address:
  • Phone: 443-333-2970
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code261QM0850X
TaxonomyAdult Mental Health Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: MR. DENNIS LORENZO WINKLER JR.
Title or Position: MANAGING MEMBER
Credential: M.S., LGPC, NCC
Phone: 443-333-2970