Provider Demographics
NPI:1114777513
Name:ONE STOP WELLNESS
Entity Type:Organization
Organization Name:ONE STOP WELLNESS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:LATIFAT
Authorized Official - Middle Name:
Authorized Official - Last Name:RAIMI
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:347-455-1225
Mailing Address - Street 1:6340 SECURITY BLVD STE 100
Mailing Address - Street 2:
Mailing Address - City:BALTIMORE
Mailing Address - State:MD
Mailing Address - Zip Code:21207-5284
Mailing Address - Country:US
Mailing Address - Phone:347-455-1225
Mailing Address - Fax:410-701-7292
Practice Address - Street 1:6340 SECURITY BLVD STE 100
Practice Address - Street 2:
Practice Address - City:BALTIMORE
Practice Address - State:MD
Practice Address - Zip Code:21207-5284
Practice Address - Country:US
Practice Address - Phone:347-455-1225
Practice Address - Fax:410-701-7292
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-03-26
Last Update Date:2024-03-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes261QM0801XAmbulatory Health Care FacilitiesClinic/CenterMental Health (Including Community Mental Health Center)
No363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental HealthGroup - Multi-Specialty