=====================================================
General NPI Number Information
=====================================================
NPI Number | 1740141688
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | LIFE MATTERS WELLNESS
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 11/20/2025
-----------------------------------------------------
Last Update Date | 11/20/2025
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 139 N MAIN ST STE 202
-----------------------------------------------------
City | BEL AIR
-----------------------------------------------------
State | MD
-----------------------------------------------------
Zip | 21014-8800
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 443-226-5495
-----------------------------------------------------
Fax | 410-431-3564
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 139 N MAIN ST STE 202
-----------------------------------------------------
City | BEL AIR
-----------------------------------------------------
State | MD
-----------------------------------------------------
Zip | 21014-8800
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 443-226-5495
-----------------------------------------------------
Fax | 410-431-3564
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | OWNER/OPERATOR
-----------------------------------------------------
Name | DR. TONI ALLAYNE BOULWARE STACKHOUSE
-----------------------------------------------------
Credential | LCPC
-----------------------------------------------------
Telephone | 144-322-6549
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 101YM0800X
-----------------------------------------------------
Taxonomy Name | Mental Health Counselor
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------