Healthcare Provider Details

I. General information

NPI: 1518547447
Provider Name (Legal Business Name): DEVOTED WELLNESS AND COUNSELING SERVICES LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/13/2021
Last Update Date: 11/20/2021
Certification Date: 11/20/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

28 W WASHINGTON ST STE 2
HAGERSTOWN MD
21740-6688
US

IV. Provider business mailing address

28 W WASHINGTON ST STE 2
HAGERSTOWN MD
21740-6688
US

V. Phone/Fax

Practice location:
  • Phone: 301-247-9039
  • Fax:
Mailing address:
  • Phone: 301-247-9039
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251S00000X
TaxonomyCommunity/Behavioral Health Agency
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code261QR0400X
TaxonomyRehabilitation Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: SERAPHINE AGBOR
Title or Position: OWNER
Credential: CRNP
Phone: 301-247-9039