Healthcare Provider Details

I. General information

NPI: 1194445833
Provider Name (Legal Business Name): COME HEALED, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/01/2022
Last Update Date: 09/01/2022
Certification Date: 08/03/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

16106 POND MEADOW LN
BOWIE MD
20716-1849
US

IV. Provider business mailing address

16106 POND MEADOW LN
BOWIE MD
20716-1849
US

V. Phone/Fax

Practice location:
  • Phone: 301-326-3697
  • Fax:
Mailing address:
  • Phone: 301-326-3697
  • 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: ALEXIS HARRIS
Title or Position: CEO
Credential:
Phone: 301-326-3697