Healthcare Provider Details

I. General information

NPI: 1417861956
Provider Name (Legal Business Name): HIGH POINT COMMUNITY WELLNESS
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/01/2026
Last Update Date: 10/01/2026
Certification Date: 10/01/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2255 CRAIN HWY STE 105
WALDORF MD
20601-3186
US

IV. Provider business mailing address

6340 SECURITY BLVD STE B34
GWYNN OAK MD
21207-5173
US

V. Phone/Fax

Practice location:
  • Phone: 410-565-2683
  • Fax:
Mailing address:
  • Phone: 410-565-2683
  • Fax:

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 StateNULL

VIII. Authorized Official

Name: MR. BYRON RANDALL
Title or Position: OWNER
Credential:
Phone: 410-565-2683