| Addiction Wellness Center Llc | |
|
5438 Sandy Hill Rd Ste A Quantico MD 21856-2100 | |
| (443) 547-2964 | |
| Not Available |
| Full Name | Addiction Wellness Center Llc |
|---|---|
| Speciality | Clinic/center - Mental Health (including Community Mental Health Center) |
| Location | 5438 Sandy Hill Rd Ste A, Quantico, Maryland |
| Authorized Official Name and Position | Jessie Costley (CREDENTIALING SPECIALIST) |
| Authorized Official Contact | 4438396928 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Addiction Wellness Center Llc 5438 Sandy Hill Rd Ste A Quantico MD 21856-2100 Ph: (443) 547-2964 | Addiction Wellness Center Llc 5438 Sandy Hill Rd Ste A Quantico MD 21856-2100 Ph: (443) 547-2964 |
| NPI Number | 1275203275 |
|---|---|
| Provider Enumeration Date | 09/20/2021 |
| Last Update Date | 01/13/2025 |
| Certification Date | 01/13/2025 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1275203275 | NPI | - | NPPES |
| 987178100 | Medicaid | MD |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 261QM0801X | Clinic/center - Mental Health (including Community Mental Health Center) | (* (Not Available)) | Primary |