Healthcare Provider Details

I. General information

NPI: 1366261703
Provider Name (Legal Business Name): DREAM WORKS HEALTH AND WELLNESS, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/03/2024
Last Update Date: 10/03/2024
Certification Date: 10/03/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4223 BELMAR AVE
BALTIMORE MD
21206-1945
US

IV. Provider business mailing address

4223 BELMAR AVE
BALTIMORE MD
21206-1945
US

V. Phone/Fax

Practice location:
  • Phone: 410-885-4558
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QR0405X
TaxonomySubstance Use Disorder Rehabilitation Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: JESSIE COSTLEY
Title or Position: CREDENTIALING SPECIALIST
Credential:
Phone: 443-839-6928