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General NPI Number Information
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NPI Number | 1952991986
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Entity Type | Organization
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Legal Business Name | 5 ELEMENTS COACHING LLC
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Dates
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Enumeration Date | 01/23/2021
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Last Update Date | 08/31/2021
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Provider Practice Location Address
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Address Line | 226 N POTOMAC ST
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City | HAGERSTOWN
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State | MD
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Zip | 21740-3813
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Country | US
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Telephone | 240-406-4857
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Fax | 240-202-2476
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Provider Business Mailing Address
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Address Line | 19813 LEITERSBURG PIKE # 193
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City | HAGERSTOWN
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State | MD
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Zip | 21742-1445
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Country | US
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Telephone | 240-406-4857
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Fax | 240-202-2476
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Authorized Official
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Title or Position | OWNER
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Name | LINNETTE JOHNSON
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Credential |
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Telephone | 240-818-3064
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261Q00000X
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Taxonomy Name | Clinic/Center
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License Number |
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License Number State |
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