Healthcare Provider Details

I. General information

NPI: 1861274086
Provider Name (Legal Business Name): DIY WELLNESS, DISCOVERING THE INDIVIDUAL IN YOU, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/23/2023
Last Update Date: 05/26/2026
Certification Date: 05/26/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

910 REVOLUTION ST
HAVRE DE GRACE MD
21078-3718
US

IV. Provider business mailing address

82 LIBERTY ST
ABERDEEN MD
21001-3821
US

V. Phone/Fax

Practice location:
  • Phone: 410-919-9665
  • Fax:
Mailing address:
  • Phone: 410-919-9665
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

Name: MRS. LISA MARIE WAINWRIGHT
Title or Position: OWNER/FOUNDER, CEO, THERAPIST
Credential: LCSW-C, MBA
Phone: 410-919-9665