MEDICARE: WELLNESS ON PURPOSE LLC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	101Y00000X	Counselor

General Provider Information

NPI Number	:	1013648211
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	WELLNESS ON PURPOSE LLC

Provider Business Mailing Address
First Line	:	1243 SIMMS PLACE NE
Second Line	:	SUITE 10
City	:	WASHINGTON
State	:	DC
Zip	:	20002-7831
Country	:	US
Telephone Number	:	202-644-9434
Fax Number	:	202-844-6964

Provider Business Practice Location Address
First Line	:	1243 SIMMS PLACE NE
Second Line	:	SUITE 10
City	:	WASHINGTON
State	:	DC
Zip	:	20002-7831
Country	:	US
Telephone Number	:	202-644-9434
Fax Number	:	202-844-6964

Authorized Official
Title or Position	:	OWNER
Name	:	MRS. DEBORAH CAMPBELL
Credential	:	LPC
Telephone Number	:	202-644-9434

Provider Enumeration Date	:	06/20/2022
Last Update Date	:	06/20/2022

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Directions to “WELLNESS ON PURPOSE LLC ” Practice Location

Language	Start Address	Practice Location

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