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General NPI Number Information
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NPI Number | 1053805564
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Entity Type | Organization
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Legal Business Name | SUSTAINABILITY WELLNESS, LLC
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Dates
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Enumeration Date | 06/18/2018
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Last Update Date | 06/18/2018
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Provider Practice Location Address
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Address Line | 8415 BELLONA LN STE 202
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City | TOWSON
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State | MD
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Zip | 21204-2066
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Country | US
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Telephone | 443-846-6009
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Fax |
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Provider Business Mailing Address
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Address Line | 8415 BELLONA LN STE 202
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City | TOWSON
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State | MD
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Zip | 21204-2066
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Country | US
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Telephone | 443-846-6009
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Fax |
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Authorized Official
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Title or Position | LICENSED MASSAGE THERAPIST/OWNER
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Name | MR. ERIC S. JONES WILLIAMS
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Credential | LMT
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Telephone | 443-846-6009
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 225700000X
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Taxonomy Name | Massage Therapist
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License Number | M05929
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License Number State | MD
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