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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 OF SPECIAL PROJECTS)
(410) 241-6317
Entity
Organization
Contact information
Practice address
4200 FORBES BLVD, SUITE104, LANHAM, MD 20706-4342
(301) 429-6100
(301) 429-1333
Mailing address
4128 HAYWARD AVE, BALTIMORE, MD 21215-4340
(410) 241-6317
Taxonomy
Speciality
Code
Description
License number
State
261QM0801X
Mental Health Clinic/Center (Including Community Mental Health Center)
Primary
—
—
261QM0855X
Adolescent and Children Mental Health Clinic/Center
—
—
261QR0405X
Substance Use Disorder Rehabilitation Clinic/Center
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
200710000
MARYLAND BEHAVIORAL HEALTH ADMINISTRATION
MD
01
—
200710001
MARYLAND BEHAVIORAL HEALTH ADMINISTRATION
MD
01
—
200710002
MARYLAND BEHAVIORAL HEALTH ADMINISTRATION
MD
01
—
220412453
MARYLAND BEHAVIORAL HEALTH ADMINISTRATION
MD
01
—
220412507
MARYLAND BEHAVIORAL HEALTH ADMINISTRATION
MD
Enumeration date
09/17/2008
Last updated
12/07/2022
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