Organization
CLOVER PATH WELLNESS LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
LERA ISON CRNP (ADMINISTRATOR)
(817) 319-6878
Entity
Organization
Contact information
Practice address
754 N HICKORY AVE STE B, BEL AIR, MD 21014-3042
(410) 286-1258
(443) 231-3684
Mailing address
754 N HICKORY AVE STE B, BEL AIR, MD 21014-3042
(410) 286-1258
(443) 231-3684
Taxonomy
Speciality
Code
Description
License number
State
324500000X
Substance Abuse Rehabilitation Facility
Primary
—
—
Other
Enumeration date
04/25/2024
Last updated
04/25/2024
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