Provider Demographics
NPI:1780362095
Name:MERIDIEN WELLNESS, LLC
Entity type:Organization
Organization Name:MERIDIEN WELLNESS, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:LAWRENCE
Authorized Official - Middle Name:
Authorized Official - Last Name:SIDBURY
Authorized Official - Suffix:JR
Authorized Official - Credentials:DHA
Authorized Official - Phone:301-641-9351
Mailing Address - Street 1:6946 FOREST HILL AVE
Mailing Address - Street 2:
Mailing Address - City:RICHMOND
Mailing Address - State:VA
Mailing Address - Zip Code:23225-1606
Mailing Address - Country:US
Mailing Address - Phone:804-381-0351
Mailing Address - Fax:804-999-0625
Practice Address - Street 1:6946 FOREST HILL AVE
Practice Address - Street 2:
Practice Address - City:RICHMOND
Practice Address - State:VA
Practice Address - Zip Code:23225-1606
Practice Address - Country:US
Practice Address - Phone:804-381-0351
Practice Address - Fax:804-999-0625
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-07-06
Last Update Date:2024-12-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health