=====================================================
General NPI Number Information
=====================================================
NPI Number | 1639053549
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | DIY WELLNESS, DISCOVERING THE INDIVIDUAL IN YOU, LLC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 08/04/2025
-----------------------------------------------------
Last Update Date | 08/04/2025
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 910 REVOLUTION ST
-----------------------------------------------------
City | HAVRE DE GRACE
-----------------------------------------------------
State | MD
-----------------------------------------------------
Zip | 21078-3718
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 410-919-9665
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 82 LIBERTY ST
-----------------------------------------------------
City | ABERDEEN
-----------------------------------------------------
State | MD
-----------------------------------------------------
Zip | 21001-3821
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 443-739-0627
-----------------------------------------------------
Fax | 443-739-0627
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | OWNER / THERAPIST
-----------------------------------------------------
Name | LISA MARIE WAINWRIGHT
-----------------------------------------------------
Credential | LCSW
-----------------------------------------------------
Telephone | 443-739-0627
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 133N00000X
-----------------------------------------------------
Taxonomy Name | Nutritionist
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------
Taxonomy #2
-----------------------------------------------------
Taxonomy Code | 163WN1003X
-----------------------------------------------------
Taxonomy Name | Nutrition Support Registered Nurse
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------
Taxonomy #3
-----------------------------------------------------
Taxonomy Code | 202D00000X
-----------------------------------------------------
Taxonomy Name | Integrative Medicine Physician
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------
Taxonomy #4
-----------------------------------------------------
Taxonomy Code | 225700000X
-----------------------------------------------------
Taxonomy Name | Massage Therapist
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------
Taxonomy #5
-----------------------------------------------------
Taxonomy Code | 171100000X
-----------------------------------------------------
Taxonomy Name | Acupuncturist
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------