Organization
CHMG CORELIFE, LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
CAROLYN HEITHAUS (CFO)
(410) 535-8236
Entity
Organization
Contact information
Practice address
1036 SAINT NICHOLAS DR UNIT 101, WALDORF, MD 20603-4758
(240) 261-7170
Mailing address
1099 WINTERSON RD STE 300, LINTHICUM HEIGHTS, MD 21090-2279
(800) 905-3261
(443) 836-5606
Taxonomy
Speciality
Code
Description
License number
State
101YM0800X
Mental Health Counselor
—
—
104100000X
Social Worker
—
—
1041C0700X
Clinical Social Worker
Primary
—
—
2084B0002X
Obesity Medicine (Psychiatry & Neurology) Physician
—
—
363LP0808X
Psychiatric/Mental Health Nurse Practitioner
—
—
Other
Enumeration date
10/28/2022
Last updated
01/16/2024
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