Provider Demographics
NPI:1205502937
Name:AUTHENTIC HEALING HEALTH AND WELLNESS CENTER, LLC
Entity type:Organization
Organization Name:AUTHENTIC HEALING HEALTH AND WELLNESS CENTER, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CLINICAL SOCIAL WORKER
Authorized Official - Prefix:MS
Authorized Official - First Name:KATREA
Authorized Official - Middle Name:
Authorized Official - Last Name:DENSON
Authorized Official - Suffix:
Authorized Official - Credentials:LICSW, LCSW-C
Authorized Official - Phone:240-417-4681
Mailing Address - Street 1:1717 LARGO RD
Mailing Address - Street 2:
Mailing Address - City:UPPER MARLBORO
Mailing Address - State:MD
Mailing Address - Zip Code:20774-8524
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:1717 LARGO RD
Practice Address - Street 2:
Practice Address - City:UPPER MARLBORO
Practice Address - State:MD
Practice Address - Zip Code:20774-8524
Practice Address - Country:US
Practice Address - Phone:240-417-4681
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-08-22
Last Update Date:2021-08-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0850XAmbulatory Health Care FacilitiesClinic/CenterAdult Mental Health