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NPI Code Detail

MEDICARE: ONE ALKALINE LIFE, LLC

MEDICARE: ONE ALKALINE LIFE, 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
1101YM0800XMental Health Counselor

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number : 1104572775
Entity Type Code : Organization
Provider Name (Legal Business Name) : ONE ALKALINE LIFE, LLC
Provider Business Mailing Address
First Line : 1036 SAINT NICHOLAS DR UNIT 102
Second Line :
City : WALDORF
State : MD
Zip : 20603-4758
Country : US
Telephone Number : 410-934-0580
Fax Number : 410-834-1217
Provider Business Practice Location Address
First Line : 1036 SAINT NICHOLAS DR UNIT 102
Second Line :
City : WALDORF
State : MD
Zip : 20603-4758
Country : US
Telephone Number : 410-934-0580
Fax Number : 410-834-1217
Authorized Official
Title or Position : CEO
Name : LESTER STEVENS
Credential :
Telephone Number : 410-934-0581
Provider Enumeration Date : 02/23/2022
Last Update Date : 07/08/2025

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