Healthcare Provider Details

I. General information

NPI: 1942177613
Provider Name (Legal Business Name): THEIA WELLNESS, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/18/2025
Last Update Date: 10/18/2025
Certification Date: 10/18/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

222 WILLOW AVE
TOWSON MD
21286-5438
US

IV. Provider business mailing address

222 WILLOW AVE
TOWSON MD
21286-5438
US

V. Phone/Fax

Practice location:
  • Phone: 443-228-8820
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number
License Number State

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

VIII. Authorized Official

Name: KATELYN ECKSTINE
Title or Position: OWNER/PROFESSIONAL COUNSELOR
Credential: LCPC
Phone: 732-865-0885