Organization
WISE LIVING LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
REGINA MARIE FIDAZZO MA (SOLE MEMBER)
(443) 801-8848
Entity
Organization
Contact information
Practice address
408 ALLEGHENY AVE, TOWSON, MD 21204-4252
(410) 567-0090
Mailing address
1401 LA BELLE AVE, TOWSON, MD 21204-6614
Taxonomy
Speciality
Code
Description
License number
State
101YP2500X
Professional Counselor
Primary
—
—
Other
Enumeration date
05/21/2020
Last updated
05/21/2020
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