| Createwellness Llc | |
|
1111 Park Ave Baltimore MD 21201-5656 | |
| (805) 570-8079 | |
| Not Available |
| Full Name | Createwellness Llc |
|---|---|
| Speciality | Counselor |
| Location | 1111 Park Ave, Baltimore, Maryland |
| Authorized Official Name and Position | Kalkidan Zeryihun (MEMBER) |
| Authorized Official Contact | 8058705709 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Createwellness Llc 1111 Park Ave #606 Baltimore MD 21201-5612 Ph: (805) 870-5709 | Createwellness Llc 1111 Park Ave Baltimore MD 21201-5656 Ph: (805) 570-8079 |
| NPI Number | 1417602954 |
|---|---|
| Provider Enumeration Date | 02/14/2022 |
| Last Update Date | 07/27/2022 |
| Certification Date | 07/27/2022 |
| Medicare PECOS PAC ID | 8022491380 |
|---|---|
| Medicare Enrollment ID | O20220818002670 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1417602954 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 101YM0800X | Counselor - Mental Health | (* (Not Available)) | Primary |
| Provider Name | Kalkidan Zeryihun |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1649651555 PECOS PAC ID: 5294145447 Enrollment ID: I20220818002817 |
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