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General NPI Number Information
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NPI Number | 1760295976
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Entity Type | Organization
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Legal Business Name | EMERGE 2 WELLNESS SUPPORT SERVICES
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Dates
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Enumeration Date | 01/30/2025
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Last Update Date | 01/30/2025
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Provider Practice Location Address
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Address Line | 6340 SECURITY BLVD STE 100B522
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City | GWYNN OAK
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State | MD
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Zip | 21207-5173
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Country | US
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Telephone | 443-242-4908
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Fax |
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Provider Business Mailing Address
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Address Line | 6340 SECURITY BLVD STE 100B522
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City | GWYNN OAK
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State | MD
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Zip | 21207-5173
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Country | US
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Telephone | 443-242-4908
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Fax |
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Authorized Official
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Title or Position | CEO/ LIFE SKILLS FACILITATOR
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Name | KATRINA S. WILSON
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Credential | MSW. CCBT
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Telephone | 443-242-4908
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 171400000X
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Taxonomy Name | Health & Wellness Coach
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License Number |
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License Number State |
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