| Dynamic Wellness Center, Llc | |
|
4200 Edmondson Ave Ste 202 Baltimore MD 21229-1614 | |
| (443) 499-3529 | |
| Not Available |
| Full Name | Dynamic Wellness Center, Llc |
|---|---|
| Speciality | Social Worker |
| Location | 4200 Edmondson Ave Ste 202, Baltimore, Maryland |
| Authorized Official Name and Position | Joi Dyson (OWNER) |
| Authorized Official Contact | 4434168029 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Dynamic Wellness Center, Llc 3413 Copley Rd Baltimore MD 21215-7189 Ph: (443) 416-8029 | Dynamic Wellness Center, Llc 4200 Edmondson Ave Ste 202 Baltimore MD 21229-1614 Ph: (443) 499-3529 |
| NPI Number | 1053881086 |
|---|---|
| Provider Enumeration Date | 12/03/2018 |
| Last Update Date | 12/03/2018 |
| Medicare PECOS PAC ID | 7618208158 |
|---|---|
| Medicare Enrollment ID | O20191014002475 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1053881086 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 1041C0700X | Social Worker - Clinical | (* (Not Available)) | Primary |
| Provider Name | Joi Dyson |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1891023669 PECOS PAC ID: 6103969910 Enrollment ID: I20100202000514 |
| Provider Name | Daphne Ruth Bolden |
|---|---|
| Provider Type | Practitioner - Certified Clinical Nurse Specialist (cns) |
| Provider Identifiers | NPI Number: 1073861886 PECOS PAC ID: 0446550040 Enrollment ID: I20151204000052 |
| Provider Name | Ameena S Jain |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1093064073 PECOS PAC ID: 9537318787 Enrollment ID: I20170426002742 |
| Provider Name | Kehinde Oyekan |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1497390413 PECOS PAC ID: 1355753211 Enrollment ID: I20201217000710 |
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