Provider Demographics
NPI:1083163307
Name:CHESAPEAKE WELLNESS CENTER
Entity Type:Organization
Organization Name:CHESAPEAKE WELLNESS CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:SOLE MEMBER
Authorized Official - Prefix:
Authorized Official - First Name:LINDA
Authorized Official - Middle Name:JEAN
Authorized Official - Last Name:KATZ
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:410-275-8156
Mailing Address - Street 1:79 PORT HERMAN RD
Mailing Address - Street 2:
Mailing Address - City:CHESAPEAKE CITY
Mailing Address - State:MD
Mailing Address - Zip Code:21915-1633
Mailing Address - Country:US
Mailing Address - Phone:410-275-8156
Mailing Address - Fax:877-433-6830
Practice Address - Street 1:251 S BOHEMIA AVE
Practice Address - Street 2:
Practice Address - City:CECILTON
Practice Address - State:MD
Practice Address - Zip Code:21913-1010
Practice Address - Country:US
Practice Address - Phone:410-275-8156
Practice Address - Fax:877-433-6830
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-09-28
Last Update Date:2016-12-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDXK8322339103TA0400X
MDH0056426207QA0401X
MDR177831363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207QA0401XAllopathic & Osteopathic PhysiciansFamily MedicineAddiction MedicineGroup - Single Specialty
No103TA0400XBehavioral Health & Social Service ProvidersPsychologistAddiction (Substance Use Disorder)Group - Single Specialty
No363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamilyGroup - Single Specialty