Healthcare Provider Details

I. General information

NPI: 1417679994
Provider Name (Legal Business Name): SGR WELLNESS LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/13/2022
Last Update Date: 09/13/2022
Certification Date: 09/13/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

849 QUINCE ORCHARD BLVD STE I
GAITHERSBURG MD
20878-1684
US

IV. Provider business mailing address

600 OAK KNOLL TER
ROCKVILLE MD
20850-7805
US

V. Phone/Fax

Practice location:
  • Phone: 240-274-5680
  • Fax:
Mailing address:
  • Phone:
  • 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: SARA ROTHLEDER
Title or Position: SOLE MEMBER
Credential: LCSW-C
Phone: 410-935-3232