# ANCIENT WIDOM HEALING ARTS

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- **Entity:** Organization
- **Status:** Active
- **Organization subpart:** No

## Provider details

- **NPI number:** 1114318094
- **Authorized official:** MR. STEVEN WILSON BROUSSARD L. AC., M.T.O.M. (VICE PRESIDENT)
- **Authorized official phone:** (443) 838-3141

## Contact information

- **Practice address:** 658 KENILWORTH DR, SUITE \#102, TOWSON, MD 21204-2312
- **Practice address phone:** (443) 838-3141
- **Practice address fax:** (410) 377-6168
- **Mailing address:** 918 WELLINGTON RD, BALTIMORE, MD 21212-1921
- **Mailing address phone:** (443) 838-3141
- **Mailing address fax:** (410) 377-6168

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 171100000X | Acupuncturist | LIC \# U01120 | MD | Yes |

## Other

- **Enumeration date:** 02/12/2015
- **Last updated:** 02/12/2015