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General NPI Number Information
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NPI Number | 1730723701
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Entity Type | Organization
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Legal Business Name | PARK WELLNESS GROUP LLC
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Dates
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Enumeration Date | 11/03/2019
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Last Update Date | 11/03/2019
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Provider Practice Location Address
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Address Line | 517 BENFIELD RD STE 100
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City | SEVERNA PARK
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State | MD
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Zip | 21146-2527
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Country | US
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Telephone | 410-216-4421
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Fax |
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Provider Business Mailing Address
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Address Line | 508 LIKESTON CT
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City | SEVERNA PARK
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State | MD
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Zip | 21146-1722
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Country | US
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Telephone | 803-493-5657
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | ASHLEY DOOT
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Credential | LCSWC
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Telephone | 803-493-5657
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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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