# ADDICTION WELLNESS CENTER LLC

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- **Entity:** Organization
- **Status:** Active
- **Parent organization:** ADDICTION WELLNESS CENTER LLC
- **Organization subpart:** Yes

## Provider details

- **NPI number:** 1912760877
- **Legal business name:** ADDICTION WELLNESS CENTER LLC
- **Authorized official:** JESSIE COSTLEY (CREDENTIALING SPECIALIST)
- **Authorized official phone:** (443) 839-6928

## Contact information

- **Practice address:** 5438 SANDY HILL RD STE A, QUANTICO, MD 21856-2100
- **Practice address phone:** (443) 547-2964
- **Mailing address:** 5438 SANDY HILL RD STE A, QUANTICO, MD 21856-2100
- **Mailing address phone:** (443) 547-2964

## Taxonomy

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

## Other

- **Enumeration date:** 02/02/2024
- **Last updated:** 02/28/2025