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General NPI Number Information
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NPI Number | 1851348536
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Entity Type | Organization
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Legal Business Name | MARYLAND WELLNESS LLC
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Dates
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Enumeration Date | 05/28/2006
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Last Update Date | 04/16/2025
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Provider Practice Location Address
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Address Line | 4200 FORBES BLVD STE 104
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City | LANHAM
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State | MD
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Zip | 20706-4342
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Country | US
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Telephone | 301-429-6100
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Fax | 301-429-1333
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Provider Business Mailing Address
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Address Line | 4128 HAYWARD AVE
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City | BALTIMORE
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State | MD
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Zip | 21215-4340
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Country | US
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Telephone | 410-241-6317
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Fax |
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Authorized Official
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Title or Position | CREDENTIALING SPECIALIST
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Name | SIERRA BURLEY
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Credential |
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Telephone | 410-314-1030
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 2084P0800X
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Taxonomy Name | Psychiatry Physician
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 261QR0405X
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Taxonomy Name | Substance Use Disorder Rehabilitation Clinic/Center
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License Number |
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License Number State |
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Taxonomy #3
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Taxonomy Code | 261QM0801X
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Taxonomy Name | Mental Health Clinic/Center (Including Community Mental Health Center)
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License Number |
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License Number State |
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