Provider Demographics
NPI:1720622103
Name:ACHIEVING WELLNESS CENTER LLC
Entity Type:Organization
Organization Name:ACHIEVING WELLNESS CENTER LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGER
Authorized Official - Prefix:MR
Authorized Official - First Name:MARK
Authorized Official - Middle Name:A
Authorized Official - Last Name:BERNARD
Authorized Official - Suffix:
Authorized Official - Credentials:LMSW, CAC-AD
Authorized Official - Phone:443-570-4837
Mailing Address - Street 1:2513 THORNBERRY DR
Mailing Address - Street 2:
Mailing Address - City:EDGEWOOD
Mailing Address - State:MD
Mailing Address - Zip Code:21040-2829
Mailing Address - Country:US
Mailing Address - Phone:443-570-4837
Mailing Address - Fax:
Practice Address - Street 1:4307 W FOREST PARK AVE
Practice Address - Street 2:
Practice Address - City:BALTIMORE
Practice Address - State:MD
Practice Address - Zip Code:21207-7451
Practice Address - Country:US
Practice Address - Phone:443-570-4837
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-10-29
Last Update Date:2019-10-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health