Provider Demographics
NPI:1720722986
Name:WIMBERLEY WELLNESS, LLC
Entity Type:Organization
Organization Name:WIMBERLEY WELLNESS, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER, THERAPIST
Authorized Official - Prefix:
Authorized Official - First Name:VAUGHAN
Authorized Official - Middle Name:R
Authorized Official - Last Name:WIMBERLEY
Authorized Official - Suffix:
Authorized Official - Credentials:LCSW-C
Authorized Official - Phone:443-374-8686
Mailing Address - Street 1:3500 BOSTON ST STE 421
Mailing Address - Street 2:
Mailing Address - City:BALTIMORE
Mailing Address - State:MD
Mailing Address - Zip Code:21224-5281
Mailing Address - Country:US
Mailing Address - Phone:443-374-8686
Mailing Address - Fax:
Practice Address - Street 1:3500 BOSTON ST STE 421
Practice Address - Street 2:
Practice Address - City:BALTIMORE
Practice Address - State:MD
Practice Address - Zip Code:21224-5281
Practice Address - Country:US
Practice Address - Phone:410-907-7656
Practice Address - Fax:410-457-3205
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-04-25
Last Update Date:2022-04-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Single Specialty