Healthcare Provider Details

I. General information

NPI: 1306488267
Provider Name (Legal Business Name): WHOLE LIFE CENTER, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/11/2019
Last Update Date: 10/11/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4324 YORK RD FL 2
BALTIMORE MD
21212-4846
US

IV. Provider business mailing address

614 N AUGUSTA AVE
BALTIMORE MD
21229-1801
US

V. Phone/Fax

Practice location:
  • Phone: 443-416-8864
  • Fax:
Mailing address:
  • Phone:
  • 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: MRS. CHARMEIKA LEWIS
Title or Position: SOCIAL WORKER
Credential: LCSW-C
Phone: 443-416-8864