Organization
AWAKE & ROOTED WELLNESS & RECOVERY, LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MALCOLM LEE BROADNAX LCADC,LGPC (OWNER)
(443) 528-0822
Entity
Organization
Contact information
Practice address
4412 COLE FARM RD, NOTTINGHAM, MD 21236-2961
(443) 528-0822
Mailing address
4412 COLE FARM RD, NOTTINGHAM, MD 21236-2961
Taxonomy
Speciality
Code
Description
License number
State
101YA0400X
Addiction (Substance Use Disorder) Counselor
Primary
—
—
261QR0405X
Substance Use Disorder Rehabilitation Clinic/Center
—
—
Other
Enumeration date
06/04/2025
Last updated
09/04/2025
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