Organization
ADDICTION WELLNESS CENTER LLC
Active
Organization
ADDICTION WELLNESS CENTER LLC
Active
Parent organization
ADDICTION WELLNESS CENTER LLC
Organization subpart
Yes
Provider details
NPI number
Legal business name
ADDICTION WELLNESS CENTER LLC
Authorized official
JESSIE COSTLEY (CREDENTIALING SPECIALIST)
(443) 839-6928
Entity
Organization
Contact information
Practice address
5438 SANDY HILL RD STE A, QUANTICO, MD 21856-2100
(443) 547-2964
Mailing address
5438 SANDY HILL RD STE A, QUANTICO, MD 21856-2100
(443) 547-2964
Taxonomy
Speciality
Code
Description
License number
State
363LA2200X
Adult Health Nurse Practitioner
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
213477200
—
MD
Enumeration date
02/02/2024
Last updated
02/28/2025
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