Provider Demographics
NPI:1053830729
Name:TRINITY WELLNESS GROUP LLC
Entity Type:Organization
Organization Name:TRINITY WELLNESS GROUP LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:ANITRA
Authorized Official - Middle Name:DAWN
Authorized Official - Last Name:PAYNE
Authorized Official - Suffix:
Authorized Official - Credentials:LCSW-C
Authorized Official - Phone:313-213-3377
Mailing Address - Street 1:1101 IVY CLUB LN UNIT 132
Mailing Address - Street 2:
Mailing Address - City:LANDOVER
Mailing Address - State:MD
Mailing Address - Zip Code:20785-4508
Mailing Address - Country:US
Mailing Address - Phone:313-213-3377
Mailing Address - Fax:
Practice Address - Street 1:1101 IVY CLUB LN UNIT 132
Practice Address - Street 2:
Practice Address - City:LANDOVER
Practice Address - State:MD
Practice Address - Zip Code:20785-4508
Practice Address - Country:US
Practice Address - Phone:313-213-3377
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-09-14
Last Update Date:2017-09-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD213691041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Single Specialty