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Organization
MARYLAND WELLNESS LLC
Active
Organization
MARYLAND WELLNESS LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
CASEY WU (DIRECTOR)
(214) 659-1503
Entity
Organization
Contact information
Practice address
2255 CRAIN HWY STE 106, WALDORF, MD 20601-3186
(410) 314-1030
(410) 314-1030
Mailing address
4128 HAYWARD AVE # W, BALTIMORE, MD 21215-4340
(410) 314-1030
(410) 314-1030
Taxonomy
Speciality
Code
Description
License number
State
261QM0801X
Mental Health Clinic/Center (Including Community Mental Health Center)
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
220412457
MD DEPARTMENT OF HEALTH - OMHC
MD
Enumeration date
01/27/2023
Last updated
03/07/2023
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