# LIFES ENERGY WELLNESS CENTER INC.

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

## Provider details

- **NPI number:** 1578125340
- **Authorized official:** ANDREA KELLEY-FREEMAN MS, LCADC, LCPC (CEO)
- **Authorized official phone:** (800) 867-2395

## Contact information

- **Practice address:** 2324 WEST ZION ROAD SUITE 112, SUITE 112, SALISBURY, MD 21804
- **Practice address phone:** (800) 867-2395
- **Mailing address:** PO BOX 123, EASTON, MD 21601-8901
- **Mailing address phone:** (800) 867-2395
- **Mailing address fax:** (410) 443-0842

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 101YA0400X | Addiction (Substance Use Disorder) Counselor | — | NULL | — |
| 101YA0400X | Addiction (Substance Use Disorder) Counselor | — | — | — |
| 101YM0800X | Mental Health Counselor | — | NULL | Yes |
| 101YM0800X | Mental Health Counselor | — | — | Yes |
| 103TA0400X | Addiction (Substance Use Disorder) Psychologist | — | NULL | — |
| 103TA0400X | Addiction (Substance Use Disorder) Psychologist | — | — | — |
| 103TB0200X | Cognitive & Behavioral Psychologist | — | NULL | — |
| 103TB0200X | Cognitive & Behavioral Psychologist | — | — | — |
| 103TC0700X | Clinical Psychologist | — | NULL | — |
| 103TC0700X | Clinical Psychologist | — | — | — |
| 103TF0000X | Family Psychologist | — | NULL | — |
| 103TF0000X | Family Psychologist | — | — | — |
| 103TF0200X | Forensic Psychologist | — | NULL | — |
| 103TF0200X | Forensic Psychologist | — | — | — |
| 103TP2701X | Group Psychotherapy Psychologist | — | NULL | — |
| 103TP2701X | Group Psychotherapy Psychologist | — | — | — |
| 103TR0400X | Rehabilitation Psychologist | — | NULL | — |
| 103TR0400X | Rehabilitation Psychologist | — | — | — |
| 1041C0700X | Clinical Social Worker | — | NULL | — |
| 1041C0700X | Clinical Social Worker | — | — | — |
| 106H00000X | Marriage & Family Therapist | — | NULL | — |
| 106H00000X | Marriage & Family Therapist | — | — | — |
| 163WA0400X | Addiction (Substance Use Disorder) Registered Nurse | — | NULL | — |
| 163WA0400X | Addiction (Substance Use Disorder) Registered Nurse | — | — | — |
| 163WP0807X | Child & Adolescent Psychiatric/Mental Health Registered Nurse | — | NULL | — |
| 163WP0807X | Child & Adolescent Psychiatric/Mental Health Registered Nurse | — | — | — |
| 2084N0400X | Neurology Physician | — | NULL | — |
| 2084N0400X | Neurology Physician | — | — | — |
| 2084P0804X | Child & Adolescent Psychiatry Physician | — | NULL | — |
| 2084P0804X | Child & Adolescent Psychiatry Physician | — | — | — |

## Other

- **Enumeration date:** 07/02/2019
- **Last updated:** 07/02/2019