Healthcare Provider Details

I. General information

NPI: 1376322990
Provider Name (Legal Business Name): THIS PLACE WELLNESS LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/22/2023
Last Update Date: 09/22/2023
Certification Date: 09/20/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3735 GIBBONS AVE
BALTIMORE MD
21206-4128
US

IV. Provider business mailing address

3735 GIBBONS AVE
BALTIMORE MD
21206-4128
US

V. Phone/Fax

Practice location:
  • Phone: 443-760-7992
  • Fax:
Mailing address:
  • Phone: 443-760-7992
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251S00000X
TaxonomyCommunity/Behavioral Health Agency
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code261QM0801X
TaxonomyMental Health Clinic/Center (Including Community Mental Health Center)
License Number
License Number State

VIII. Authorized Official

Name: FELICIA ABASS
Title or Position: CEO
Credential: MS, CAC-AD
Phone: 443-760-7992