Organization
ADDICTION WELLNESS CENTER OK LLC
Active
Organization
ADDICTION WELLNESS CENTER OK LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
JESSIE COSTLEY (CREDENTIALING SPECIALIST)
(443) 839-6928
Entity
Organization
Contact information
Practice address
1800 E MEMORIAL RD STE 101, OKLAHOMA CITY, OK 73131-1827
(405) 446-5714
Mailing address
1100 BUSINESS PKWY S STE 1, WESTMINSTER, MD 21157-3048
Taxonomy
Speciality
Code
Description
License number
State
251S00000X
Community/Behavioral Health Agency
Primary
—
—
363L00000X
Nurse Practitioner
—
—
363LA2200X
Adult Health Nurse Practitioner
—
—
Other
Enumeration date
05/17/2023
Last updated
04/23/2026
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