Provider Demographics
NPI:1700241577
Name:STATE OF WELLNESS, INC
Entity Type:Organization
Organization Name:STATE OF WELLNESS, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:MICHAELA
Authorized Official - Middle Name:ANN
Authorized Official - Last Name:CONLEY
Authorized Official - Suffix:
Authorized Official - Credentials:MS, MCHES
Authorized Official - Phone:410-715-2268
Mailing Address - Street 1:9622 BASKET RING ROAD
Mailing Address - Street 2:
Mailing Address - City:COLUMBIA
Mailing Address - State:MD
Mailing Address - Zip Code:21045-3418
Mailing Address - Country:US
Mailing Address - Phone:410-715-2268
Mailing Address - Fax:443-926-9565
Practice Address - Street 1:9622 BASKET RING ROAD
Practice Address - Street 2:
Practice Address - City:COLUMBIA
Practice Address - State:MD
Practice Address - Zip Code:21045-3418
Practice Address - Country:US
Practice Address - Phone:410-715-2268
Practice Address - Fax:433-925-9565
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-12-22
Last Update Date:2015-12-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD174H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174H00000XOther Service ProvidersHealth EducatorGroup - Single Specialty