LIFES ENERGY WELLNESS CENTER INC.

Provider Demographics

• NPI: 1174189658
• Name: LIFES ENERGY WELLNESS CENTER INC.
• Entity Type: Organization
• Organization Name: LIFES ENERGY WELLNESS CENTER INC.
• Other - Org Name: LIFE'S ENERGY WELLNESS CENTER INC.
• Other - Org Type: Doing Business As
• Authorized Official - Title/Position: CEO
• Authorized Official - First Name: ANDREA
• Authorized Official - Last Name: KELLEY-FREEMAN
• Authorized Official - Phone: 800-867-2395
• Mailing Address - Street 1: PO BOX 123
• Mailing Address - City: EASTON
• Mailing Address - State: MD
• Mailing Address - Zip Code: 21601-8901
• Mailing Address - Country: US
• Mailing Address - Phone: 800-867-2395
• Mailing Address - Fax: 410-443-0842
• Practice Address - Street 1: 514 POPLAR ST
• Practice Address - City: CAMBRIDGE
• Practice Address - State: MD
• Practice Address - Zip Code: 21613-1834
• Practice Address - Country: US
• Practice Address - Phone: 800-867-2395
• Practice Address - Fax: 410-443-0842
• EIN: <UNAVAIL>
• Is Organization Subpart?: No
• Enumeration Date: 2019-05-10
• Last Update Date: 2019-05-15

Provider Taxonomies

Primary?	Code	Type	Classification	Specialization	Group
Yes	261QM0801X	Ambulatory Health Care Facilities	Clinic/Center	Mental Health (Including Community Mental Health Center)
No	101YA0400X	Behavioral Health & Social Service Providers	Counselor	Addiction (Substance Use Disorder)	Group - Multi-Specialty
No	101YM0800X	Behavioral Health & Social Service Providers	Counselor	Mental Health	Group - Multi-Specialty
No	101YP2500X	Behavioral Health & Social Service Providers	Counselor	Professional	Group - Multi-Specialty
No	103TA0400X	Behavioral Health & Social Service Providers	Psychologist	Addiction (Substance Use Disorder)	Group - Multi-Specialty
No	103TC2200X	Behavioral Health & Social Service Providers	Psychologist	Clinical Child & Adolescent	Group - Multi-Specialty
No	1041C0700X	Behavioral Health & Social Service Providers	Social Worker	Clinical	Group - Multi-Specialty
No	163WA0400X	Nursing Service Providers	Registered Nurse	Addiction (Substance Use Disorder)	Group - Multi-Specialty
No	2084A0401X	Allopathic & Osteopathic Physicians	Psychiatry & Neurology	Addiction Medicine	Group - Multi-Specialty
No	2084P0800X	Allopathic & Osteopathic Physicians	Psychiatry & Neurology	Psychiatry	Group - Multi-Specialty
No	2084P0804X	Allopathic & Osteopathic Physicians	Psychiatry & Neurology	Child & Adolescent Psychiatry	Group - Multi-Specialty
No	261QM0850X	Ambulatory Health Care Facilities	Clinic/Center	Adult Mental Health	Group - Multi-Specialty
No	261QM1300X	Ambulatory Health Care Facilities	Clinic/Center	Multi-Specialty	Group - Multi-Specialty
No	363LP0808X	Physician Assistants & Advanced Practice Nursing Providers	Nurse Practitioner	Psychiatric/Mental Health	Group - Multi-Specialty
No	364SP0810X	Physician Assistants & Advanced Practice Nursing Providers	Clinical Nurse Specialist	Psychiatric/Mental Health, Child & Family	Group - Multi-Specialty