Healthcare Provider Details

I. General information

NPI: 1619729076
Provider Name (Legal Business Name): WELBON INTEGRATED SUPPORTIVE HEALTHCARE
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/01/2024
Last Update Date: 03/19/2025
Certification Date: 03/19/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

233 E REDWOOD ST STE 500A
BALTIMORE MD
21202-6292
US

IV. Provider business mailing address

233 E REDWOOD ST STE 500A
BALTIMORE MD
21202-6292
US

V. Phone/Fax

Practice location:
  • Phone: 410-204-5534
  • Fax:
Mailing address:
  • Phone: 410-204-5534
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code261QM0850X
TaxonomyAdult Mental Health Clinic/Center
License Number
License Number StateNULL
# 2
Primary TaxonomyY
Taxonomy Code261QR0405X
TaxonomySubstance Use Disorder Rehabilitation Clinic/Center
License Number
License Number StateNULL
# 3
Primary TaxonomyN
Taxonomy Code175T00000X
TaxonomyPeer Specialist
License Number
License Number StateNULL

VIII. Authorized Official

Name: BENITA WELBON
Title or Position: CEO/PRESIDENT
Credential:
Phone: 240-217-7212