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General NPI Number Information
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NPI Number | 1104711704
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Entity Type | Organization
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Legal Business Name | MARYLAND WELLNESS LLC
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Dates
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Enumeration Date | 06/12/2025
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Last Update Date | 06/12/2025
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Provider Practice Location Address
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Address Line | 519 N MECHANIC ST
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City | CUMBERLAND
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State | MD
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Zip | 21502-2133
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Country | US
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Telephone | 301-777-9600
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Fax | 301-245-6746
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Provider Business Mailing Address
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Address Line | 4128 HAYWARD AVE
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City | BALTIMORE
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State | MD
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Zip | 21215-4340
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Country | US
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Telephone | 410-314-1030
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Fax | 410-205-1673
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Authorized Official
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Title or Position | CREDENTIALING SPECIALIST
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Name | SIERRA BURLEY
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Credential |
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Telephone | 410-314-1030
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QM0850X
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Taxonomy Name | Adult Mental Health Clinic/Center
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License Number |
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License Number State |
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