Provider Demographics
NPI:1740141688
Name:LIFE MATTERS WELLNESS
Entity type:Organization
Organization Name:LIFE MATTERS WELLNESS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/OPERATOR
Authorized Official - Prefix:DR
Authorized Official - First Name:TONI
Authorized Official - Middle Name:ALLAYNE
Authorized Official - Last Name:BOULWARE STACKHOUSE
Authorized Official - Suffix:
Authorized Official - Credentials:LCPC
Authorized Official - Phone:144-322-6549
Mailing Address - Street 1:139 N MAIN ST STE 202
Mailing Address - Street 2:
Mailing Address - City:BEL AIR
Mailing Address - State:MD
Mailing Address - Zip Code:21014-8800
Mailing Address - Country:US
Mailing Address - Phone:443-226-5495
Mailing Address - Fax:410-431-3564
Practice Address - Street 1:139 N MAIN ST STE 202
Practice Address - Street 2:
Practice Address - City:BEL AIR
Practice Address - State:MD
Practice Address - Zip Code:21014-8800
Practice Address - Country:US
Practice Address - Phone:443-226-5495
Practice Address - Fax:410-431-3564
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2025-11-20
Last Update Date:2025-11-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Multi-Specialty