Healthcare Provider Details

I. General information

NPI: 1528901857
Provider Name (Legal Business Name): STI HEALTH & WELLNESS LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/13/2026
Last Update Date: 04/13/2026
Certification Date: 04/12/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2288 BLUE WATER BLVD STE 5
ODENTON MD
21113-3309
US

IV. Provider business mailing address

11106 PROSPECT HILL RD
GLENN DALE MD
20769-9454
US

V. Phone/Fax

Practice location:
  • Phone: 301-352-9048
  • Fax: 301-352-9050
Mailing address:
  • Phone: 301-352-9048
  • Fax: 301-352-9050

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code251B00000X
TaxonomyCase Management Agency
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code261QM0801X
TaxonomyMental Health Clinic/Center (Including Community Mental Health Center)
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code261QM0850X
TaxonomyAdult Mental Health Clinic/Center
License Number
License Number State
# 4
Primary TaxonomyN
Taxonomy Code261QM0855X
TaxonomyAdolescent and Children Mental Health Clinic/Center
License Number
License Number State
# 5
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number State

VIII. Authorized Official

Name: PRISCILLA CHARLES
Title or Position: PRESIDENT/OWNER
Credential:
Phone: 301-352-9048