Provider Demographics
NPI:1104490978
Name:THERAPEUTIC WELLNESS SERVICES CORP
Entity type:Organization
Organization Name:THERAPEUTIC WELLNESS SERVICES CORP
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MISS
Authorized Official - First Name:ARTEARA
Authorized Official - Middle Name:
Authorized Official - Last Name:WATKINS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:443-934-2320
Mailing Address - Street 1:4909 LIBERTY HEIGHTS AVE FL 2
Mailing Address - Street 2:
Mailing Address - City:BALTIMORE
Mailing Address - State:MD
Mailing Address - Zip Code:21207-8235
Mailing Address - Country:US
Mailing Address - Phone:443-934-2320
Mailing Address - Fax:410-665-3001
Practice Address - Street 1:4909 LIBERTY HEIGHTS AVE
Practice Address - Street 2:
Practice Address - City:BALTIMORE
Practice Address - State:MD
Practice Address - Zip Code:21207-8235
Practice Address - Country:US
Practice Address - Phone:410-665-3000
Practice Address - Fax:410-665-3001
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:THERAPETIC WELLNESS SERVICES CORP
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2021-05-17
Last Update Date:2022-05-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0801XAmbulatory Health Care FacilitiesClinic/CenterMental Health (Including Community Mental Health Center)
Provider Identifiers
StateIdentifier IDID TypeIssuer
MDW19619980Medicaid