Healthcare Provider Details

I. General information

NPI: 1518446004
Provider Name (Legal Business Name): WELLSPRING RESTORATIVE THERAPY SERVICES
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/07/2018
Last Update Date: 11/27/2024
Certification Date: 11/06/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

12510 PROSPERITY DR STE 180
SILVER SPRING MD
20904-1695
US

IV. Provider business mailing address

11821 PARKLAWN DR STE 105
ROCKVILLE MD
20852-2539
US

V. Phone/Fax

Practice location:
  • Phone: 301-650-5940
  • Fax: 240-465-0070
Mailing address:
  • Phone: 301-650-5940
  • Fax: 301-650-5945

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 Code251E00000X
TaxonomyHome Health Agency
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code251S00000X
TaxonomyCommunity/Behavioral Health Agency
License Number
License Number State
# 4
Primary TaxonomyN
Taxonomy Code253Z00000X
TaxonomyIn Home Supportive Care Agency
License Number
License Number State
# 5
Primary TaxonomyN
Taxonomy Code385H00000X
TaxonomyRespite Care
License Number
License Number State

VIII. Authorized Official

Name: DONNA MASON MITCHELL
Title or Position: CEO
Credential: MBA, LCPC
Phone: 301-650-5940