Healthcare Provider Details

I. General information

NPI: 1336808914
Provider Name (Legal Business Name): UKARE WELLNESS CLINIC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/10/2021
Last Update Date: 10/23/2024
Certification Date: 10/23/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

12530 FAIRWOOD PKWY STE 102
BOWIE MD
20720-6357
US

IV. Provider business mailing address

12530 FAIRWOOD PKWY STE 102
BOWIE MD
20720-6357
US

V. Phone/Fax

Practice location:
  • Phone: 240-547-7966
  • Fax:
Mailing address:
  • Phone: 240-547-7966
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

Name: OBI HERBERTS
Title or Position: CREDENTIALING SPECIALIST
Credential:
Phone: 410-213-5494