Healthcare Provider Details

I. General information

NPI: 1528705530
Provider Name (Legal Business Name): COMPLETE HEALTH WELLNESS GROUP LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/19/2022
Last Update Date: 10/06/2024
Certification Date: 10/06/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

815 RITCHIE HWY STE 205
SEVERNA PARK MD
21146-4164
US

IV. Provider business mailing address

204 SAINT CHARLES WAY UNIT E BOX 372
YORK PA
17402-4646
US

V. Phone/Fax

Practice location:
  • Phone: 443-367-1333
  • Fax:
Mailing address:
  • Phone: 443-367-1333
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code104100000X
TaxonomySocial Worker
License Number
License Number State
# 4
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number
License Number State
# 5
Primary TaxonomyN
Taxonomy Code225X00000X
TaxonomyOccupational Therapist
License Number
License Number State

VIII. Authorized Official

Name: RYAN K
Title or Position: MANAGER
Credential:
Phone: 443-367-1333