Provider Demographics
NPI:1417602954
Name:CREATEWELLNESS LLC
Entity Type:Organization
Organization Name:CREATEWELLNESS LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MEMBER
Authorized Official - Prefix:
Authorized Official - First Name:KALKIDAN
Authorized Official - Middle Name:
Authorized Official - Last Name:ZERYIHUN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:805-870-5709
Mailing Address - Street 1:1111 PARK AVE #606
Mailing Address - Street 2:
Mailing Address - City:BALTIMORE
Mailing Address - State:MD
Mailing Address - Zip Code:21201-5612
Mailing Address - Country:US
Mailing Address - Phone:805-870-5709
Mailing Address - Fax:
Practice Address - Street 1:1111 PARK AVE
Practice Address - Street 2:
Practice Address - City:BALTIMORE
Practice Address - State:MD
Practice Address - Zip Code:21201-5656
Practice Address - Country:US
Practice Address - Phone:805-570-8079
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-02-14
Last Update Date:2022-07-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Single Specialty