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General NPI Number Information
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NPI Number | 1902475353
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Entity Type | Organization
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Legal Business Name | SAGE MENTAL WELLNESS
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Dates
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Enumeration Date | 06/21/2021
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Last Update Date | 05/31/2024
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Provider Practice Location Address
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Address Line | 309 E PATRICK ST
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City | FREDERICK
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State | MD
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Zip | 21701-6792
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Country | US
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Telephone | 253-355-5342
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Fax |
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Provider Business Mailing Address
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Address Line | 250 ANTIETAM DR
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City | FALLING WATERS
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State | WV
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Zip | 25419-4880
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Country | US
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Telephone | 253-355-5342
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | AUDRA WORTHINGTON
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Credential |
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Telephone | 240-310-9961
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363LP0808X
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Taxonomy Name | Psychiatric/Mental Health Nurse Practitioner
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License Number |
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License Number State |
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