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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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