MEDICARE: PREMIER WELLNESS HEALTHCARE

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	101YM0800X	Mental Health Counselor
2	103TC0700X	Clinical Psychologist

Other Identifiers

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

General Provider Information

NPI Number	:	1376087635
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	PREMIER WELLNESS HEALTHCARE

Provider Business Mailing Address
First Line	:	133 BLACK OAK TRL
Second Line	:
City	:	DELTA
State	:	PA
Zip	:	17314-8756
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	2209 COMMERCE RD STE 1
Second Line	:
City	:	FOREST HILL
State	:	MD
Zip	:	21050-2539
Country	:	US
Telephone Number	:	888-333-1345
Fax Number	:	410-734-2025

Authorized Official
Title or Position	:	OWNER
Name	:	CYNTHIA DICARA
Credential	:
Telephone Number	:	888-333-1345

Provider Enumeration Date	:	12/06/2016
Last Update Date	:	06/09/2026

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Directions to “PREMIER WELLNESS HEALTHCARE ” Practice Location

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