Healthcare Provider Details

I. General information

NPI: 1811519564
Provider Name (Legal Business Name): WOMENS HEALING CENTER LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/15/2020
Last Update Date: 05/15/2020
Certification Date: 05/15/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8167 MAIN ST STE 206
ELLICOTT CITY MD
21043-4776
US

IV. Provider business mailing address

11970 LITTLE PATUXENT PKWY APT K
COLUMBIA MD
21044-4805
US

V. Phone/Fax

Practice location:
  • Phone: 443-535-1544
  • Fax:
Mailing address:
  • Phone: 480-272-2128
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QM0850X
TaxonomyAdult Mental Health Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: NANCY A WIKES
Title or Position: OWNER
Credential: LCSW-C
Phone: 480-272-2128