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
2255 CRAIN HWY STE 106, WALDORF, MD 20601-3186
(410) 314-1030
(410) 314-1030
Mailing address
4128 HAYWARD AVE # W, BALTIMORE, MD 21215-4340
(410) 314-1030
(410) 314-1030
Taxonomy
Speciality
Code
Description
License number
State
324500000X
Substance Abuse Rehabilitation Facility
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
220412455
MD DEPARTMENT OF HEALTH - LEVEL 1 - OUTPATIENT TREATMENT PROGRAM
MD
01
—
220412456
MD DEPARTMENT OF HEALTH - LEVEL 2.1 - INTENSIVE OUTPATIENT TREATMENT PROGRAM
MD
Enumeration date
01/20/2023
Last updated
04/16/2025
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