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General NPI Number Information
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NPI Number | 1932612835
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Entity Type | Organization
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Legal Business Name | EXECUTIVE WELLNESS LLC
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Dates
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Enumeration Date | 11/14/2017
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Last Update Date | 11/14/2017
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Provider Practice Location Address
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Address Line | 4545 42ND ST NW STE 204
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City | WASHINGTON
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State | DC
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Zip | 20016-4623
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Country | US
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Telephone | 301-284-0696
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Fax |
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Provider Business Mailing Address
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Address Line | 9727 MOUNT PISGAH RD APT 613
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City | SILVER SPRING
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State | MD
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Zip | 20903-2024
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Country | US
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Telephone | 321-514-5339
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Fax |
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Authorized Official
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Title or Position | CEO
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Name | MS. KAREN BUEHLER
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Credential | LPC, LCPC
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Telephone | 301-284-0696
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 101YP2500X
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Taxonomy Name | Professional Counselor
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License Number | PRC14719
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License Number State | DC
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