Provider Demographics
NPI:1093694481
Name:HUCKLEBERRY WELLNESS
Entity type:Organization
Organization Name:HUCKLEBERRY WELLNESS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:FOUNDER & CLINICIAN
Authorized Official - Prefix:
Authorized Official - First Name:CAROLINE
Authorized Official - Middle Name:LOUISE
Authorized Official - Last Name:HUBBARD PINEAU
Authorized Official - Suffix:
Authorized Official - Credentials:LCSW-C
Authorized Official - Phone:667-425-8000
Mailing Address - Street 1:2320 E BALTIMORE ST
Mailing Address - Street 2:
Mailing Address - City:BALTIMORE
Mailing Address - State:MD
Mailing Address - Zip Code:21224-1031
Mailing Address - Country:US
Mailing Address - Phone:202-257-1333
Mailing Address - Fax:
Practice Address - Street 1:2320 E BALTIMORE ST
Practice Address - Street 2:
Practice Address - City:BALTIMORE
Practice Address - State:MD
Practice Address - Zip Code:21224-1031
Practice Address - Country:US
Practice Address - Phone:202-257-1333
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2025-08-29
Last Update Date:2025-08-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD1356118897OtherCMS