Healthcare Provider Details

I. General information

NPI: 1013782713
Provider Name (Legal Business Name): ACCESS TO WHOLISTIC AND PRODUCTIVE LIVING INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/22/2023
Last Update Date: 11/22/2023
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3611 43RD AVE.
COLMAR MANOR MD
20722
US

IV. Provider business mailing address

3611 43RD AVE.
COLMAR MANOR MD
20722
US

V. Phone/Fax

Practice location:
  • Phone: 240-264-0878
  • Fax:
Mailing address:
  • Phone: 240-264-0878
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251B00000X
TaxonomyCase Management Agency
License Number
License Number StateNULL
# 2
Primary TaxonomyN
Taxonomy Code174H00000X
TaxonomyHealth Educator
License Number
License Number StateNULL

VIII. Authorized Official

Name: DR. BETTYE MUWWAKKIL
Title or Position: CEO
Credential:
Phone: 240-264-0878