Provider Demographics
NPI:1396387254
Name:WELLNESS TO WHOLENESS LLC
Entity Type:Organization
Organization Name:WELLNESS TO WHOLENESS LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MEMBER
Authorized Official - Prefix:
Authorized Official - First Name:MALGORZATA
Authorized Official - Middle Name:
Authorized Official - Last Name:NUSSBAUM
Authorized Official - Suffix:
Authorized Official - Credentials:LCMFT, LMFT, LAC
Authorized Official - Phone:443-782-5630
Mailing Address - Street 1:212 ARCHER ST STE A
Mailing Address - Street 2:
Mailing Address - City:BEL AIR
Mailing Address - State:MD
Mailing Address - Zip Code:21014-3681
Mailing Address - Country:US
Mailing Address - Phone:443-782-5630
Mailing Address - Fax:443-808-2628
Practice Address - Street 1:212 ARCHER ST STE A
Practice Address - Street 2:
Practice Address - City:BEL AIR
Practice Address - State:MD
Practice Address - Zip Code:21014-3681
Practice Address - Country:US
Practice Address - Phone:443-782-5630
Practice Address - Fax:443-808-2628
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-10-11
Last Update Date:2020-05-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD225053500Medicaid