Healthcare Provider Details

I. General information

NPI: 1104604099
Provider Name (Legal Business Name): ALLIANCE WELLNESS SOLUTIONS LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/20/2023
Last Update Date: 06/11/2026
Certification Date: 06/11/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

920 PROVIDENCE RD STE 101
TOWSON MD
21286-2979
US

IV. Provider business mailing address

920 PROVIDENCE RD STE 101
TOWSON MD
21286-2979
US

V. Phone/Fax

Practice location:
  • Phone: 667-400-3679
  • Fax: 667-400-3626
Mailing address:
  • Phone: 667-400-3679
  • Fax: 667-400-3626

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QM0801X
TaxonomyMental Health Clinic/Center (Including Community Mental Health Center)
License Number
License Number State

VIII. Authorized Official

Name: MR. PHILLIP KENDALL
Title or Position: CHIEF EXECUTIVE OFFICER
Credential: LCSW-C
Phone: 410-275-8181