Healthcare Provider Details

I. General information

NPI: 1558904938
Provider Name (Legal Business Name): WELLNESS COUNSELING CENTER, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/18/2019
Last Update Date: 12/21/2022
Certification Date: 12/21/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8503 GREENS LN
WINDSOR MILL MD
21244-1124
US

IV. Provider business mailing address

8503 GREENS LN
WINDSOR MILL MD
21244-1124
US

V. Phone/Fax

Practice location:
  • Phone: 443-629-2424
  • Fax:
Mailing address:
  • Phone: 443-629-2424
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
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: MS. QUIZZINA FORNEY
Title or Position: OWNER
Credential: LCSW-C
Phone: 443-629-2424