Healthcare Provider Details

I. General information

NPI: 1235074378
Provider Name (Legal Business Name): KONTRE WELLNESS & OUTPATIENT SERVICES, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/23/2026
Last Update Date: 05/31/2026
Certification Date: 05/31/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2706 CHELSEA TER
BALTIMORE MD
21216-1725
US

IV. Provider business mailing address

2706 CHELSEA TER
BALTIMORE MD
21216-1725
US

V. Phone/Fax

Practice location:
  • Phone: 443-973-4575
  • Fax:
Mailing address:
  • Phone: 443-973-4575
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number
License Number State

VIII. Authorized Official

Name: MARJUIN V CAMPBELL-MASSALEE
Title or Position: PROPRIETOR
Credential: LCSW-C
Phone: 443-973-4575