Provider Demographics
NPI:1437911294
Name:VILLAGE ELITE WELLNESS, LLC
Entity Type:Organization
Organization Name:VILLAGE ELITE WELLNESS, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:VALERIE
Authorized Official - Middle Name:
Authorized Official - Last Name:MARKS
Authorized Official - Suffix:
Authorized Official - Credentials:PHD, LCSW-C
Authorized Official - Phone:443-608-0786
Mailing Address - Street 1:2104 EASTRIDGE RD
Mailing Address - Street 2:
Mailing Address - City:LUTHERVILLE
Mailing Address - State:MD
Mailing Address - Zip Code:21093-3432
Mailing Address - Country:US
Mailing Address - Phone:443-608-0786
Mailing Address - Fax:
Practice Address - Street 1:9603 DEERECO RD UNIT 306
Practice Address - Street 2:
Practice Address - City:LUTHERVILLE
Practice Address - State:MD
Practice Address - Zip Code:21094-7514
Practice Address - Country:US
Practice Address - Phone:443-608-0786
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-01-26
Last Update Date:2024-01-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health