Healthcare Provider Details

I. General information

NPI: 1487599916
Provider Name (Legal Business Name): PEONY MENTAL WELLNESS LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/21/2026
Last Update Date: 04/21/2026
Certification Date: 04/21/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5223 ILCHESTER RD
ELLICOTT CITY MD
21043-7041
US

IV. Provider business mailing address

4380 MONTGOMERY RD STE 1028B
ELLICOTT CITY MD
21043-6112
US

V. Phone/Fax

Practice location:
  • Phone: 443-791-6325
  • Fax:
Mailing address:
  • Phone:
  • 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: STEVEN REGISTER
Title or Position: TREASURER
Credential:
Phone: 443-791-6325