# BLACKWATER WELLNESS, LLC

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

## Provider details

- **NPI number:** 1477253862
- **Authorized official:** BRANDY DAWSON CUMBERLAND CRNP-PMH (PROVIDER)
- **Authorized official phone:** (410) 205-6477

## Contact information

- **Practice address:** 7 CEDAR ST STE 3, CAMBRIDGE, MD 21613-2381
- **Practice address phone:** (410) 205-6477
- **Mailing address:** 2855 CROCHERON RD, CROCHERON, MD 21627-1201
- **Mailing address phone:** (443) 521-6656

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 363LP0808X | Psychiatric/Mental Health Nurse Practitioner | — | NULL | Yes |
| 363LP0808X | Psychiatric/Mental Health Nurse Practitioner | — | — | Yes |

## Other

- **Enumeration date:** 03/06/2023
- **Last updated:** 10/15/2024