# AWAKE & ROOTED WELLNESS & RECOVERY, LLC

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

## Provider details

- **NPI number:** 1407740582
- **Authorized official:** MALCOLM LEE BROADNAX LCADC,LGPC (OWNER)
- **Authorized official phone:** (443) 528-0822

## Contact information

- **Practice address:** 4412 COLE FARM RD, NOTTINGHAM, MD 21236-2961
- **Practice address phone:** (443) 528-0822
- **Mailing address:** 4412 COLE FARM RD, NOTTINGHAM, MD 21236-2961

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 101YA0400X | Addiction (Substance Use Disorder) Counselor | — | NULL | Yes |
| 101YA0400X | Addiction (Substance Use Disorder) Counselor | — | — | Yes |
| 261QR0405X | Substance Use Disorder Rehabilitation Clinic/Center | — | NULL | — |

## Other

- **Enumeration date:** 06/04/2025
- **Last updated:** 09/04/2025