Organization
WELLNESS SOURCE LLC
Active
Other names
Your Wellness Sources
Organization subpart
No
Provider details
NPI number
Authorized official
MARSHALEE GEORGE (MEDICAL DIRECTOR)
(301) 235-0060
Entity
Organization
Contact information
Practice address
4301 GARDEN CITY DR STE 304, HYATTSVILLE, MD 20785-6105
(301) 235-0060
Mailing address
6305 IVY LN STE 101, GREENBELT, MD 20770-6326
(301) 235-0060
Taxonomy
Speciality
Code
Description
License number
State
1041C0700X
Clinical Social Worker
—
—
363LP0808X
Psychiatric/Mental Health Nurse Practitioner
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
192174600
—
MD
05
—
600082700
—
MD
05
—
600082701
—
MD
05
—
601006700
—
MH
Enumeration date
03/14/2018
Last updated
11/13/2020
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