Provider Demographics
NPI:1629353719
Name:TOTAL WELLNESS
Entity Type:Organization
Organization Name:TOTAL WELLNESS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:VARSHA
Authorized Official - Middle Name:
Authorized Official - Last Name:KUNNIRICKAL
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:240-475-6817
Mailing Address - Street 1:723 S CHARLES ST
Mailing Address - Street 2:SUITE 103
Mailing Address - City:BALTIMORE
Mailing Address - State:MD
Mailing Address - Zip Code:21230-3811
Mailing Address - Country:US
Mailing Address - Phone:410-605-0180
Mailing Address - Fax:410-605-0181
Practice Address - Street 1:723 S CHARLES ST
Practice Address - Street 2:SUITE 103
Practice Address - City:BALTIMORE
Practice Address - State:MD
Practice Address - Zip Code:21230-3811
Practice Address - Country:US
Practice Address - Phone:410-605-0180
Practice Address - Fax:410-605-0181
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-10-20
Last Update Date:2011-10-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselorGroup - Multi-Specialty
No104100000XBehavioral Health & Social Service ProvidersSocial WorkerGroup - Multi-Specialty
No106H00000XBehavioral Health & Social Service ProvidersMarriage & Family TherapistGroup - Multi-Specialty
No136A00000XDietary & Nutritional Service ProvidersDietetic Technician, RegisteredGroup - Multi-Specialty