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General NPI Number Information
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NPI Number | 1720722986
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Entity Type | Organization
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Legal Business Name | WIMBERLEY WELLNESS, LLC
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Dates
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Enumeration Date | 04/25/2022
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Last Update Date | 04/28/2022
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Provider Practice Location Address
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Address Line | 3500 BOSTON ST STE 421
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City | BALTIMORE
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State | MD
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Zip | 21224-5281
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Country | US
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Telephone | 410-907-7656
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Fax | 410-457-3205
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Provider Business Mailing Address
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Address Line | 3500 BOSTON ST STE 421
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City | BALTIMORE
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State | MD
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Zip | 21224-5281
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Country | US
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Telephone | 443-374-8686
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Fax |
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Authorized Official
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Title or Position | OWNER, THERAPIST
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Name | VAUGHAN R WIMBERLEY
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Credential | LCSW-C
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Telephone | 443-374-8686
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1041C0700X
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Taxonomy Name | Clinical Social Worker
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License Number |
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License Number State |
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