Healthcare Provider Details

I. General information

NPI: 1548090657
Provider Name (Legal Business Name): THERAPEUTIC EMPOWERMENT AND WELLNESS, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/05/2024
Last Update Date: 01/24/2026
Certification Date: 01/24/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

518 S CAMP MEADE RD STE 4
LINTHICUM HEIGHTS MD
21090-2766
US

IV. Provider business mailing address

5764 YELLOWROSE CT
COLUMBIA MD
21045-2500
US

V. Phone/Fax

Practice location:
  • Phone: 302-495-9773
  • Fax: 443-583-5596
Mailing address:
  • Phone: 302-495-9773
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code261QM0801X
TaxonomyMental Health Clinic/Center (Including Community Mental Health Center)
License Number
License Number State

VIII. Authorized Official

Name: CHRISTINA JOHNSON
Title or Position: CEO/OWNER
Credential:
Phone: 410-693-2382