Provider Demographics
NPI:1487220281
Name:WELLBROOK BEHAVIORAL HEALTH SERVICES
Entity Type:Organization
Organization Name:WELLBROOK BEHAVIORAL HEALTH SERVICES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:DR
Authorized Official - First Name:KIMBERLY
Authorized Official - Middle Name:
Authorized Official - Last Name:WAIBOGHA
Authorized Official - Suffix:
Authorized Official - Credentials:LCSW-C
Authorized Official - Phone:304-322-0275
Mailing Address - Street 1:5764 STEVENS FOREST RD APT 322
Mailing Address - Street 2:
Mailing Address - City:COLUMBIA
Mailing Address - State:MD
Mailing Address - Zip Code:21045-3758
Mailing Address - Country:US
Mailing Address - Phone:410-935-5177
Mailing Address - Fax:410-695-3778
Practice Address - Street 1:5764 STEVENS FOREST RD APT 322
Practice Address - Street 2:
Practice Address - City:COLUMBIA
Practice Address - State:MD
Practice Address - Zip Code:21045-3758
Practice Address - Country:US
Practice Address - Phone:410-935-5177
Practice Address - Fax:410-695-3778
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-06-02
Last Update Date:2023-04-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes261QM0801XAmbulatory Health Care FacilitiesClinic/CenterMental Health (Including Community Mental Health Center)
No103TC1900XBehavioral Health & Social Service ProvidersPsychologistCounselingGroup - Single Specialty
No1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Single Specialty