Healthcare Provider Details

I. General information

NPI: 1700717485
Provider Name (Legal Business Name): WELLNESS HEALTH SERVICES LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/29/2026
Last Update Date: 05/29/2026
Certification Date: 05/29/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5900 YORK RD STE 206
BALTIMORE MD
21212-3098
US

IV. Provider business mailing address

11202 MARWOOD HILL DR
POTOMAC MD
20854-1241
US

V. Phone/Fax

Practice location:
  • Phone: 678-641-3444
  • Fax:
Mailing address:
  • Phone: 678-641-3444
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code261QM0850X
TaxonomyAdult Mental Health Clinic/Center
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code261QM0801X
TaxonomyMental Health Clinic/Center (Including Community Mental Health Center)
License Number
License Number State

VIII. Authorized Official

Name: ANDRE TCHOUKOUAHA
Title or Position: DIRECTOR OF OPERATIONS
Credential:
Phone: 678-641-3444