| Illumine Llc | |
|
605 Post Office Rd Ste 301 Waldorf MD 20602-1913 | |
| (301) 928-6045 | |
| Not Available |
| Full Name | Illumine Llc |
|---|---|
| Speciality | Counselor - Professional |
| Location | 605 Post Office Rd Ste 301, Waldorf, Maryland |
| Authorized Official Name and Position | Wade Morgan Green (PARTNER) |
| Authorized Official Contact | 3019286045 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Illumine Llc 605 Post Office Rd Ste 301 Waldorf MD 20602-1913 Ph: (301) 928-6045 | Illumine Llc 605 Post Office Rd Ste 301 Waldorf MD 20602-1913 Ph: (301) 928-6045 |
| NPI Number | 1750742664 |
|---|---|
| Provider Enumeration Date | 03/19/2016 |
| Last Update Date | 03/19/2016 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1750742664 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 101YP2500X | Counselor - Professional | LC2196 (Maryland) | Primary |
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