Healthcare Provider Details

I. General information

NPI: 1811505076
Provider Name (Legal Business Name): COMPLETE WELLNESS, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/14/2020
Last Update Date: 07/14/2020
Certification Date: 07/14/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10 W MADISON ST STE 11
BALTIMORE MD
21201-2313
US

IV. Provider business mailing address

10 W MADISON ST STE 11
BALTIMORE MD
21201-2313
US

V. Phone/Fax

Practice location:
  • Phone: 443-438-7863
  • Fax: 443-957-9485
Mailing address:
  • Phone: 443-438-7863
  • Fax: 443-957-9485

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103T00000X
TaxonomyPsychologist
License Number
License Number State

VIII. Authorized Official

Name: WILLIAM DURWOOD WHITTEN
Title or Position: PRESIDENT
Credential: PHD
Phone: 443-438-7863