=====================================================
General NPI Number Information
=====================================================
NPI Number | 1992681639
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | M&T WELLNESS FUSION LLC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 08/15/2025
-----------------------------------------------------
Last Update Date | 08/15/2025
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 438 R MAIN STREET STE 2, 3, 4
-----------------------------------------------------
City | REISTERSTOWN
-----------------------------------------------------
State | MD
-----------------------------------------------------
Zip | 21136
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 800-671-8193
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 5 EMPIRE CT
-----------------------------------------------------
City | REISTERSTOWN
-----------------------------------------------------
State | MD
-----------------------------------------------------
Zip | 21136-6410
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 443-413-9989
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | OWNER
-----------------------------------------------------
Name | MONET DUCKETT
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 800-671-8193
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 324500000X
-----------------------------------------------------
Taxonomy Name | Substance Abuse Rehabilitation Facility
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------