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General NPI Number Information
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NPI Number | 1164174959
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Entity Type | Organization
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Legal Business Name | COMPLETE 180 CONSULTING GROUP, LLC
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Dates
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Enumeration Date | 01/22/2022
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Last Update Date | 01/24/2022
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Provider Practice Location Address
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Address Line | 540 GROVETHORN RD
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City | MIDDLE RIVER
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State | MD
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Zip | 21220-4906
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Country | US
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Telephone | 443-882-7619
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Fax |
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Provider Business Mailing Address
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Address Line | 540 GROVETHORN RD
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City | MIDDLE RIVER
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State | MD
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Zip | 21220-4906
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Country | US
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Telephone | 443-882-7619
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | MS. MISTY MYERS
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Credential | MA
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Telephone | 443-882-7619
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QH0100X
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Taxonomy Name | Health Service Clinic/Center
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License Number |
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License Number State |
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