Healthcare Provider Details

I. General information

NPI: 1205321106
Provider Name (Legal Business Name): SUSTAINABILITY WELLNESS LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/25/2018
Last Update Date: 06/25/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8415 BELLONA LN STE 202
TOWSON MD
21204-2066
US

IV. Provider business mailing address

8415 BELLONA LN STE 202
TOWSON MD
21204-2066
US

V. Phone/Fax

Practice location:
  • Phone: 443-846-6009
  • Fax:
Mailing address:
  • Phone: 443-846-6009
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code171100000X
TaxonomyAcupuncturist
License NumberU02157
License Number StateMD
# 2
Primary TaxonomyN
Taxonomy Code225700000X
TaxonomyMassage Therapist
License NumberM05929
License Number StateMD

VIII. Authorized Official

Name: ERIC SCOTT JONES WILLIAMS
Title or Position: OWNER/MASSAGE THERAPIST/INSTRUCTOR
Credential: LMT
Phone: 443-846-6009