Provider Demographics
NPI:1497256002
Name:WHITE LOTUS WELLNESS CENTER, LLC
Entity Type:Organization
Organization Name:WHITE LOTUS WELLNESS CENTER, LLC
Other - Org Name:WHITE LOTUS WELLNESS CENTER, LLC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:FOUNDER
Authorized Official - Prefix:MRS
Authorized Official - First Name:ANNE ATEEKA
Authorized Official - Middle Name:B
Authorized Official - Last Name:CONTEE
Authorized Official - Suffix:
Authorized Official - Credentials:MBA
Authorized Official - Phone:240-391-6742
Mailing Address - Street 1:4912 BERWYN RD
Mailing Address - Street 2:
Mailing Address - City:COLLEGE PARK
Mailing Address - State:MD
Mailing Address - Zip Code:20740-2111
Mailing Address - Country:US
Mailing Address - Phone:240-391-6742
Mailing Address - Fax:
Practice Address - Street 1:4912 BERWYN RD
Practice Address - Street 2:
Practice Address - City:COLLEGE PARK
Practice Address - State:MD
Practice Address - Zip Code:20740-2111
Practice Address - Country:US
Practice Address - Phone:240-391-6742
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-02-28
Last Update Date:2018-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDLGP8489261QM0801X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0801XAmbulatory Health Care FacilitiesClinic/CenterMental Health (Including Community Mental Health Center)