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General NPI Number Information
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NPI Number | 1467306068
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Entity Type | Organization
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Legal Business Name | BACK 2 BASICS NUTRITION LLC
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Dates
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Enumeration Date | 02/23/2026
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Last Update Date | 02/23/2026
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Provider Practice Location Address
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Address Line | 10753 BIRMINGHAM WAY
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City | WOODSTOCK
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State | MD
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Zip | 21163-1535
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Country | US
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Telephone | 240-200-4010
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Fax | 443-280-6441
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Provider Business Mailing Address
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Address Line | 5216 CHAIRMANS CT STE 104
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City | FREDERICK
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State | MD
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Zip | 21703-2858
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Country | US
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Telephone | 240-200-4010
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Fax | 443-280-6441
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Authorized Official
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Title or Position | OWNER
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Name | LINDSEY GILL CARTER
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Credential |
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Telephone | 410-598-4336
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 101Y00000X
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Taxonomy Name | Counselor
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License Number |
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License Number State |
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