Healthcare Provider Details

I. General information

NPI: 1528665858
Provider Name (Legal Business Name): WELLNESS TOGETHER, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/09/2020
Last Update Date: 10/09/2020
Certification Date: 10/09/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

16 DADE CT
FALLSTON MD
21047-2944
US

IV. Provider business mailing address

16 DADE CT
FALLSTON MD
21047-2944
US

V. Phone/Fax

Practice location:
  • Phone: 410-804-4779
  • Fax:
Mailing address:
  • Phone: 410-804-4779
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number
License Number State

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

VIII. Authorized Official

Name: TONI BOSSALINA
Title or Position: PSYHOTHERAPIST
Credential: LCSWC
Phone: 410-804-4779