Provider Demographics
NPI:1225887821
Name:AMOROUS THERAPEUTIC WELLNESS
Entity type:Organization
Organization Name:AMOROUS THERAPEUTIC WELLNESS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:COO
Authorized Official - Prefix:MR
Authorized Official - First Name:ROGER
Authorized Official - Middle Name:DALE
Authorized Official - Last Name:MITCHELL
Authorized Official - Suffix:JR
Authorized Official - Credentials:
Authorized Official - Phone:301-284-0774
Mailing Address - Street 1:4942 TALL OAKS DR
Mailing Address - Street 2:
Mailing Address - City:MONROVIA
Mailing Address - State:MD
Mailing Address - Zip Code:21770-9316
Mailing Address - Country:US
Mailing Address - Phone:202-236-4760
Mailing Address - Fax:
Practice Address - Street 1:308 W PATRICK ST
Practice Address - Street 2:
Practice Address - City:FREDERICK
Practice Address - State:MD
Practice Address - Zip Code:21701-4889
Practice Address - Country:US
Practice Address - Phone:301-284-0774
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-05-15
Last Update Date:2025-01-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Multi-Specialty