| Restoration Of Wellness | |
|
4709 Harford Rd Ste 80 Baltimore MD 21214-3261 | |
| (443) 906-3884 | |
| Not Available |
| Full Name | Restoration Of Wellness |
|---|---|
| Speciality | Social Worker |
| Location | 4709 Harford Rd Ste 80, Baltimore, Maryland |
| Authorized Official Name and Position | Tasha Williams (CEO) |
| Authorized Official Contact | 4437038582 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Restoration Of Wellness 3025 Woodring Ave Parkville MD 21234-7828 Ph: (443) 703-8582 | Restoration Of Wellness 4709 Harford Rd Ste 80 Baltimore MD 21214-3261 Ph: (443) 906-3884 |
| NPI Number | 1487254272 |
|---|---|
| Provider Enumeration Date | 10/29/2020 |
| Last Update Date | 05/20/2021 |
| Certification Date | 05/20/2021 |
| Medicare PECOS PAC ID | 6305258427 |
|---|---|
| Medicare Enrollment ID | O20201215000940 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1487254272 | NPI | - | NPPES |
| 654192500 | Medicaid | MD |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 1041C0700X | Social Worker - Clinical | (* (Not Available)) | Primary |
| Provider Name | Tasha Michele Williams |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1972103752 PECOS PAC ID: 7113339235 Enrollment ID: I20201215000985 |
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