Provider Demographics
NPI:1669141487
Name:CULTIVATE WELLNESS COUNSELING, LLC
Entity type:Organization
Organization Name:CULTIVATE WELLNESS COUNSELING, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:BRANDE
Authorized Official - Middle Name:
Authorized Official - Last Name:THOMPSON
Authorized Official - Suffix:
Authorized Official - Credentials:LCPC
Authorized Official - Phone:443-272-5434
Mailing Address - Street 1:10451 MILL RUN CIR STE 725
Mailing Address - Street 2:
Mailing Address - City:OWINGS MILLS
Mailing Address - State:MD
Mailing Address - Zip Code:21117-5669
Mailing Address - Country:US
Mailing Address - Phone:443-272-5434
Mailing Address - Fax:410-888-0925
Practice Address - Street 1:10451 MILL RUN CIR STE 725
Practice Address - Street 2:
Practice Address - City:OWINGS MILLS
Practice Address - State:MD
Practice Address - Zip Code:21117-5669
Practice Address - Country:US
Practice Address - Phone:443-272-5434
Practice Address - Fax:410-888-0925
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-09-07
Last Update Date:2024-01-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Multi-Specialty