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General NPI Number Information
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NPI Number | 1578197752
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Entity Type | Organization
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Legal Business Name | NEW LIFE WELLNESS GROUP
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Dates
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Enumeration Date | 02/27/2020
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Last Update Date | 03/15/2021
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Provider Practice Location Address
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Address Line | 110 W MULBERRY ST STE 100
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City | BALTIMORE
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State | MD
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Zip | 21201-3606
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Country | US
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Telephone | 443-203-8555
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Fax |
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Provider Business Mailing Address
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Address Line | 23 RED HEARTH CT
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City | HALETHORPE
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State | MD
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Zip | 21227-3833
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Country | US
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Telephone | 443-285-9846
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Fax |
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Authorized Official
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Title or Position | CEO/COO
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Name | LONETTA MASON
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Credential | LCPC
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Telephone | 443-285-9846
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 101YA0400X
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Taxonomy Name | Addiction (Substance Use Disorder) Counselor
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 101YM0800X
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Taxonomy Name | Mental Health Counselor
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License Number |
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License Number State |
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