Healthcare Provider Details

I. General information

NPI: 1619707098
Provider Name (Legal Business Name): MARYLAND WELLNESS CENTER LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

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

III. Provider practice location address

11140 ROCKVILLE PIKE STE 421
ROCKVILLE MD
20852-3104
US

IV. Provider business mailing address

11870 GRAND PARK AVE APT 924
ROCKVILLE MD
20852-8702
US

V. Phone/Fax

Practice location:
  • Phone: 301-678-3281
  • Fax:
Mailing address:
  • Phone: 301-788-8326
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code261QH0100X
TaxonomyHealth Service Clinic/Center
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code261QM0850X
TaxonomyAdult Mental Health Clinic/Center
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code261QM0855X
TaxonomyAdolescent and Children Mental Health Clinic/Center
License Number
License Number State
# 4
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number State

VIII. Authorized Official

Name: SAMUEL ROSENBLATT
Title or Position: FOUNDER, THERAPIST
Credential: LCPC
Phone: 301-788-8326