Healthcare Provider Details

I. General information

NPI: 1508551672
Provider Name (Legal Business Name): CREATING WELLNESS, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/05/2023
Last Update Date: 04/05/2023
Certification Date: 04/05/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2518 E FAIRMOUNT AVE
BALTIMORE MD
21224-1133
US

IV. Provider business mailing address

2518 E FAIRMOUNT AVE
BALTIMORE MD
21224-1133
US

V. Phone/Fax

Practice location:
  • Phone: 984-212-2482
  • Fax:
Mailing address:
  • Phone: 984-212-2482
  • 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: ALEXANDRA BRADFORD
Title or Position: OWNER/ THERAPIST
Credential: LCSW-C
Phone: 984-212-2482