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Organization
MARYLAND WELLNESS LLC
Active
Organization
MARYLAND WELLNESS LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
SIERRA BURLEY (CREDENTIALING SPECIALIST)
(410) 314-1030
Entity
Organization
Contact information
Practice address
4200 FORBES BLVD, STE 104, 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
2084P0800X
Psychiatry Physician
—
—
261QM0801X
Mental Health Clinic/Center (Including Community Mental Health Center)
Primary
—
—
261QR0405X
Substance Use Disorder Rehabilitation Clinic/Center
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
415169100
—
MD
05
—
415169101
—
MD
05
—
415169102
—
MD
Enumeration date
05/28/2006
Last updated
04/16/2025
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