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Organization
LIFES ENERGY WELLNESS CENTER INC.
Active
Organization
LIFES ENERGY WELLNESS CENTER INC.
Active
Organization subpart
No
Provider details
NPI number
Authorized official
ANDREA KELLEY-FREEMAN (CEO)
(800) 867-2395
Entity
Organization
Contact information
Practice address
8737 BROOKS DR STE 108, SUITE 108, EASTON, MD 21601-7474
(800) 867-2395
Mailing address
PO BOX 123, EASTON, MD 21601-8901
(800) 867-2395
Taxonomy
Speciality
Code
Description
License number
State
101YA0400X
Addiction (Substance Use Disorder) Counselor
Primary
BH000383
MD
103TA0400X
Addiction (Substance Use Disorder) Psychologist
—
NULL
103TA0400X
Addiction (Substance Use Disorder) Psychologist
—
—
1041C0700X
Clinical Social Worker
—
NULL
1041C0700X
Clinical Social Worker
—
—
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
—
—
175T00000X
Peer Specialist
—
NULL
175T00000X
Peer Specialist
—
—
207QA0401X
Addiction Medicine (Family Medicine) Physician
—
NULL
207QA0401X
Addiction Medicine (Family Medicine) Physician
—
—
207RA0401X
Addiction Medicine (Internal Medicine) Physician
—
NULL
207RA0401X
Addiction Medicine (Internal Medicine) Physician
—
—
2084A0401X
Addiction Medicine (Psychiatry & Neurology) Physician
—
NULL
2084A0401X
Addiction Medicine (Psychiatry & Neurology) Physician
—
—
2084P0800X
Psychiatry Physician
—
NULL
2084P0800X
Psychiatry Physician
—
—
2084P0804X
Child & Adolescent Psychiatry Physician
—
NULL
2084P0804X
Child & Adolescent Psychiatry Physician
—
—
225C00000X
Rehabilitation Counselor
—
NULL
225C00000X
Rehabilitation Counselor
—
—
261QM1300X
Multi-Specialty Clinic/Center
—
NULL
363LP0808X
Psychiatric/Mental Health Nurse Practitioner
—
NULL
363LP0808X
Psychiatric/Mental Health Nurse Practitioner
—
—
364SH0200X
Home Health Clinical Nurse Specialist
—
NULL
364SH0200X
Home Health Clinical Nurse Specialist
—
—
Other
Enumeration date
05/04/2018
Last updated
05/04/2018
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