Provider Demographics
NPI:1669161782
Name:KALEIDOSCOPE WELLNESS AND EDUCATION GROUP LLC
Entity type:Organization
Organization Name:KALEIDOSCOPE WELLNESS AND EDUCATION GROUP LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:KENYA
Authorized Official - Middle Name:
Authorized Official - Last Name:COLEMAN
Authorized Official - Suffix:
Authorized Official - Credentials:LCSW
Authorized Official - Phone:301-202-4353
Mailing Address - Street 1:14935 NIGHTHAWK LN
Mailing Address - Street 2:
Mailing Address - City:BOWIE
Mailing Address - State:MD
Mailing Address - Zip Code:20716-1036
Mailing Address - Country:US
Mailing Address - Phone:301-202-4353
Mailing Address - Fax:
Practice Address - Street 1:14935 NIGHTHAWK LN
Practice Address - Street 2:
Practice Address - City:BOWIE
Practice Address - State:MD
Practice Address - Zip Code:20716-1036
Practice Address - Country:US
Practice Address - Phone:301-202-4353
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-05-04
Last Update Date:2023-09-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0855XAmbulatory Health Care FacilitiesClinic/CenterAdolescent and Children Mental Health