Organization
ADDICTION WELLNESS CENTER IN LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
JESSIE COSTLEY (CREDENTIALING SPECIALIST)
(443) 839-6928
Entity
Organization
Contact information
Practice address
202 E MAPLE ST, JEFFERSONVILLE, IN 47130-3420
(667) 367-8357
Mailing address
1100 BUSINESS PKWY S STE 1, WESTMINSTER, MD 21157-3048
(667) 367-8357
Taxonomy
Speciality
Code
Description
License number
State
363L00000X
Nurse Practitioner
Primary
—
—
363LA2200X
Adult Health Nurse Practitioner
—
—
363LF0000X
Family Nurse Practitioner
—
—
Other
Enumeration date
10/06/2022
Last updated
02/28/2025
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