Healthcare Provider Details

I. General information

NPI: 1780031724
Provider Name (Legal Business Name): WELLNESS SOURCE LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/19/2016
Last Update Date: 05/27/2026
Certification Date: 05/27/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4301 GARDEN CITY DR STE 304
HYATTSVILLE MD
20785-6105
US

IV. Provider business mailing address

4301 GARDEN CITY DR STE 304
HYATTSVILLE MD
20785-6105
US

V. Phone/Fax

Practice location:
  • Phone: 301-235-0060
  • Fax: 240-324-7720
Mailing address:
  • Phone: 301-235-0600
  • Fax: 240-324-7720

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code2084P0802X
TaxonomyAddiction Psychiatry Physician
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code261QP2300X
TaxonomyPrimary Care Clinic/Center
License Number
License Number State
# 4
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number
License Number State
# 5
Primary TaxonomyN
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License Number
License Number State
# 6
Primary TaxonomyN
Taxonomy Code364SP0809X
TaxonomyAdult Psychiatric/Mental Health Clinical Nurse Specialist
License Number
License Number State

VIII. Authorized Official

Name: MARSHALEE GEORGE
Title or Position: MEDICAL DIRECTOR
Credential:
Phone: 301-235-0060