# LIFES ENERGY WELLNESS CENTER INC.

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

## Provider details

- **NPI number:** 1811486962
- **Authorized official:** ANDREA KELLEY-FREEMAN (CEO)
- **Authorized official phone:** (800) 867-2395

## Contact information

- **Practice address:** 8737 BROOKS DR STE 108, SUITE 108, EASTON, MD 21601-7474
- **Practice address phone:** (800) 867-2395
- **Mailing address:** PO BOX 123, EASTON, MD 21601-8901
- **Mailing address phone:** (800) 867-2395

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 101YA0400X | Addiction (Substance Use Disorder) Counselor | BH000383 | MD | Yes |
| 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