# ADDICTION WELLNESS CENTER IN LLC

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

## Provider details

- **NPI number:** 1720703382
- **Authorized official:** JESSIE COSTLEY (CREDENTIALING SPECIALIST)
- **Authorized official phone:** (443) 839-6928

## Contact information

- **Practice address:** 202 E MAPLE ST, JEFFERSONVILLE, IN 47130-3420
- **Practice address phone:** (667) 367-8357
- **Mailing address:** 1100 BUSINESS PKWY S STE 1, WESTMINSTER, MD 21157-3048
- **Mailing address phone:** (667) 367-8357

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 363L00000X | Nurse Practitioner | — | NULL | Yes |
| 363L00000X | Nurse Practitioner | — | — | Yes |
| 363LA2200X | Adult Health Nurse Practitioner | — | NULL | — |
| 363LA2200X | Adult Health Nurse Practitioner | — | — | — |
| 363LF0000X | Family Nurse Practitioner | — | NULL | — |
| 363LF0000X | Family Nurse Practitioner | — | — | — |

## Other

- **Enumeration date:** 10/06/2022
- **Last updated:** 02/28/2025