Healthcare Provider Details

I. General information

NPI: 1538022181
Provider Name (Legal Business Name): PERSONAL WELLNESS CENTER
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/09/2025
Last Update Date: 08/07/2026
Certification Date: 08/07/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

12421 SOMERSET AVE STE 1
PRINCESS ANNE MD
21853-3021
US

IV. Provider business mailing address

6508 DEER POINTE DR STE 4C
SALISBURY MD
21804-1668
US

V. Phone/Fax

Practice location:
  • Phone: 410-742-6016
  • Fax:
Mailing address:
  • Phone: 410-742-6016
  • Fax: 410-742-6014

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code261Q00000X
TaxonomyClinic/Center
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code261QM0801X
TaxonomyMental Health Clinic/Center (Including Community Mental Health Center)
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code261QR0400X
TaxonomyRehabilitation Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: SAMANTHA YOUNG
Title or Position: OFFICE MANAGER
Credential:
Phone: 410-742-6016