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General NPI Number Information
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NPI Number | 1427695808
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Entity Type | Organization
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Legal Business Name | CONTINUUM WELLNESS CENTER LLC.
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Dates
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Enumeration Date | 12/05/2019
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Last Update Date | 12/05/2019
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Provider Practice Location Address
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Address Line | 7310 RITCHIE HWY STE 405
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City | GLEN BURNIE
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State | MD
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Zip | 21061-3092
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Country | US
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Telephone | 410-788-6727
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Fax | 410-788-6729
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Provider Business Mailing Address
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Address Line | 2 W ROLLING XRDS STE 111
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City | CATONSVILLE
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State | MD
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Zip | 21228-6204
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Country | US
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Telephone | 410-788-6727
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Fax |
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Authorized Official
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Title or Position | CLINICAL DIRECTOR/CEO
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Name | LYSTRA EASTLYN WILLIAMS
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Credential |
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Telephone | 410-788-6727
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 174H00000X
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Taxonomy Name | Health Educator
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License Number |
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License Number State |
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