Maryland Wellness LLC
Organization Active NPI Mental Health Clinic/Center (Including Community Mental Health Center) · Baltimore, MD
NPI 1003479668 · NPPES record last updated Apr 16, 2025
Key facts
- NPI
- 1003479668
- Entity type
- Organization (NPI type 2)
- Primary specialty
- Mental Health Clinic/Center (Including Community Mental Health Center) 261QM0801X
- Legal business name
- MARYLAND WELLNESS LLC
- Practice address
- 4128 Hayward Ave # W
Baltimore, MD 21215-4340 - Phone
- (410) 994-6491
- NPI assigned
- Apr 19, 2019
- Organization subpart
- No
Authorized official
- Name
- Sierra Burley
- Title
- Credentialing Specialist
- Phone
- (410) 314-1030
Other NPIs on the same Medicare enrollment 5
Corporate family (same tax ID) 38
Practitioners 5
-
Monica Reed Campbell, LCSW-C
-
Kathleen P. Maycock, LCSW-C
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled in MD
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| O20200611002298 | MD | Part B Supplier - Clinic/Group Practice | 6406278803 |
Receives reassigned benefits from 28 practitioners 5 other NPIs on this enrollment This NPI is an additional NPI on the enrollment Practice locations: Baltimore, MD; Cumberland, MD; Hagerstown, MD; Waldorf, MD |
National Provider Directory
- Tax ID family
- Maryland Wellness LLC
Locations
920 W Washington St
Ste 201
Hagerstown, MD 21740
Phone (240) 420-5555
8 Church Ln
Pikesville, MD 21208
Phone (410) 241-6317
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Group Psychotherapy Psychologist |
103TP2701X | |||
| Case Management Agency | 251B00000X | |||
| Mental Health Clinic/Center (Including Community Mental Health Center) | 261QM0801X | Yes | ||
| Substance Use Disorder Rehabilitation Clinic/Center | 261QR0405X |
Addresses
Primary practice location
4128 Hayward Ave # W
Baltimore, MD 21215-4340
Mailing address
4128 Hayward Ave # W
Baltimore, MD 21215-4340
Phone (410) 994-6491
Other practice location 1
4500 Black Rock Rd # G2
Hampstead, MD 21074-2636
Phone (410) 241-6317
Other practice location 2
519 N Mechanic St
Cumberland, MD 21502-2133
Phone (410) 241-6317
Other practice location 3
117 E Main St
Westminster, MD 21157-5012
Phone (410) 241-6317
Other practice location 4
920 W Washington St Ste 201
Hagerstown, MD 21740-2803
Phone (410) 241-6317
Other practice location 5
4200 Forbes Blvd Ste 104
Lanham, MD 20706-4872
Phone (410) 241-6317
Other practice location 6
8 Church Ln # W
Pikesville, MD 21208-3721
Phone (410) 241-6317
Other practice location 7
2255 Crain Hwy Ste 106
Waldorf, MD 20601-3186
Phone (410) 241-6317
Other identifiers
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 907713800 | Medicaid | MD | |
| 220412461 | Other | MD | MARYLAND BEHAVIORAL HEALTH ADMINISTRATION |
| 220412462 | Other | MD | MARYLAND BEHAVIORAL HEALTH ADMINISTRATION |
| 220412464 | Other | MD | MARYLAND BEHAVIORAL HEALTH ADMINISTRATION |
| 220412460 | Other | MD | MARYLAND BEHAVIORAL HEALTH ADMINISTRATION |
| 220412463 | Other | MD | MARYLAND BEHAVIORAL HEALTH ADMINISTRATION |
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All providers in Baltimore, MD · Mental Health Clinic/Center (Including Community Mental Health Center) in Maryland
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Apr 16, 2025. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- Medicare Fee-For-Service Public Provider Enrollment (CMS/PECOS): enrollments, PAC IDs and benefit reassignments.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.