Organization
IMAGINE WELLNESS, LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MRS. CRYSTAL MARIE WISSINGER M.S., LBA, BCBA (OWNER/FOUNDER)
(443) 741-2249
Entity
Organization
Contact information
Practice address
7909 BELGARO RD, LAUREL, MD 20723-1108
(443) 741-2249
(301) 725-4608
Mailing address
7909 BELGARO RD, LAUREL, MD 20723-1108
(443) 741-2249
(301) 725-4608
Taxonomy
Speciality
Code
Description
License number
State
103K00000X
Behavior Analyst
Primary
1-11-8182
MD
Other
Enumeration date
01/07/2013
Last updated
12/21/2016
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