Provider Demographics
NPI:1659618619
Name:LG WELLNESS LLC
Entity Type:Organization
Organization Name:LG WELLNESS LLC
Other - Org Name:LAURA GREER LCSW-C
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:LAURA
Authorized Official - Middle Name:R
Authorized Official - Last Name:GREER
Authorized Official - Suffix:
Authorized Official - Credentials:LCSW-C
Authorized Official - Phone:410-591-7724
Mailing Address - Street 1:6902 WALLIS AVE
Mailing Address - Street 2:
Mailing Address - City:BALTIMORE
Mailing Address - State:MD
Mailing Address - Zip Code:21215-1709
Mailing Address - Country:US
Mailing Address - Phone:410-591-7724
Mailing Address - Fax:877-376-1801
Practice Address - Street 1:17 WARREN RD
Practice Address - Street 2:SUITE 3A
Practice Address - City:BALTIMORE
Practice Address - State:MD
Practice Address - Zip Code:21208-5334
Practice Address - Country:US
Practice Address - Phone:410-591-7724
Practice Address - Fax:877-376-1801
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-01-11
Last Update Date:2013-01-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD093601041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD1891018909Medicaid