Organization
WELLNESS SOURCE LLC
Active
Other names
Your Wellness Sources
Organization subpart
No
Provider details
NPI number
Authorized official
MARSHALEE GEORGE (MEDICAL DIRECTOR)
(301) 235-0060
Entity
Organization
Contact information
Practice address
4301 GARDEN CITY DR STE 304, HYATTSVILLE, MD 20785-6105
(301) 235-0060
(240) 324-7720
Mailing address
4301 GARDEN CITY DR STE 304, HYATTSVILLE, MD 20785-6105
(301) 235-0600
Taxonomy
Speciality
Code
Description
License number
State
2084P0800X
Psychiatry Physician
—
—
2084P0802X
Addiction Psychiatry Physician
—
—
261QP2300X
Primary Care Clinic/Center
—
—
363LF0000X
Family Nurse Practitioner
Primary
—
—
363LP0808X
Psychiatric/Mental Health Nurse Practitioner
—
—
364SP0809X
Adult Psychiatric/Mental Health Clinical Nurse Specialist
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
051747821
—
DC
01
—
540582
MEDICARE PTAN
MD
05
—
600082700
—
MD
Enumeration date
05/19/2016
Last updated
03/08/2024
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