Organization
BACK 2 BASICS NUTRITION LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
LINDSEY GILL CARTER (OWNER)
(410) 598-4336
Entity
Organization
Contact information
Practice address
2028 LIBERTY RD STE 103, ELDERSBURG, MD 21784-5079
(410) 598-4336
Mailing address
2028 LIBERTY RD STE 103, ELDERSBURG, MD 21784-5079
(410) 598-4336
Taxonomy
Speciality
Code
Description
License number
State
103TC1900X
Counseling Psychologist
—
—
208000000X
Pediatrics Physician
Primary
—
—
225100000X
Physical Therapist
—
—
225X00000X
Occupational Therapist
—
—
235Z00000X
Speech-Language Pathologist
—
—
Other
Enumeration date
04/28/2022
Last updated
04/28/2022
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