Provider Demographics
NPI:1851033740
Name:ONE SOURCE WELLNESS WORKS LLC
Entity Type:Organization
Organization Name:ONE SOURCE WELLNESS WORKS LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CLINICAL DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:MAXWELL
Authorized Official - Middle Name:
Authorized Official - Last Name:MANNING
Authorized Official - Suffix:
Authorized Official - Credentials:LCSWC
Authorized Official - Phone:301-252-4392
Mailing Address - Street 1:22 W PENNSYLVANIA AVE STE 410
Mailing Address - Street 2:
Mailing Address - City:TOWSON
Mailing Address - State:MD
Mailing Address - Zip Code:21204-5017
Mailing Address - Country:US
Mailing Address - Phone:478-397-9624
Mailing Address - Fax:
Practice Address - Street 1:22 W PENNSYLVANIA AVE STE 410
Practice Address - Street 2:
Practice Address - City:TOWSON
Practice Address - State:MD
Practice Address - Zip Code:21204-5017
Practice Address - Country:US
Practice Address - Phone:478-397-9624
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-04-11
Last Update Date:2022-04-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD1730415498Medicaid