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Organization
MARYLAND WELLNESS LLC
Active
Organization
MARYLAND WELLNESS LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
SIERRA BURLEY (CREDENTIALING SPECIALIST)
(410) 314-1030
Entity
Organization
Contact information
Practice address
4128 HAYWARD AVE # W, BALTIMORE, MD 21215-4340
(410) 994-6491
Mailing address
4128 HAYWARD AVE # W, BALTIMORE, MD 21215-4340
(410) 994-6491
Taxonomy
Speciality
Code
Description
License number
State
103TP2701X
Group Psychotherapy Psychologist
—
—
251B00000X
Case Management Agency
—
—
261QM0801X
Mental Health Clinic/Center (Including Community Mental Health Center)
Primary
—
—
261QR0405X
Substance Use Disorder Rehabilitation Clinic/Center
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
220412460
MARYLAND BEHAVIORAL HEALTH ADMINISTRATION
MD
01
—
220412461
MARYLAND BEHAVIORAL HEALTH ADMINISTRATION
MD
01
—
220412462
MARYLAND BEHAVIORAL HEALTH ADMINISTRATION
MD
01
—
220412463
MARYLAND BEHAVIORAL HEALTH ADMINISTRATION
MD
01
—
220412464
MARYLAND BEHAVIORAL HEALTH ADMINISTRATION
MD
05
—
907713800
—
MD
Enumeration date
04/19/2019
Last updated
04/16/2025
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