NPIMap

Organization Active NPI

One Alkaline Life, LLC

  • Mental Health Counselor
  • Waldorf, MD
National Provider Identifier
1104572775
Registry record updated Jul 8, 2025
On this page

Key facts

NPPES NPI Registry
Primary specialty
Mental Health CounselorTaxonomy code 101YM0800X
Legal business name
ONE ALKALINE LIFE, LLC
Practice address
1036 Saint Nicholas Dr Unit 102
Waldorf, MD 20603-4758
Phone
(410) 934-0580
Fax
(410) 834-1217
NPI assigned
Feb 23, 2022
Last updated
Jul 8, 2025By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jul 8, 2025

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name
Lester Stevens
Title
Ceo
Phone
(410) 934-0581

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Mental Health Counselor 101YM0800X NU Primary

Addresses

Primary practice location

1036 Saint Nicholas Dr Unit 102
Waldorf, MD 20603-4758

Mailing address

1036 Saint Nicholas Dr Unit 102
Waldorf, MD 20603-4758
Phone (410) 934-0580

Other identifiers 1

IdentifierTypeStateIssuer
317218000MedicaidMD

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in MD

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20230202000964 MD Part B Supplier - Clinic/Group Practice 9638541568 Receives reassigned benefits from 3 practitioners
Practice locations: Waldorf, MD

National Provider Directory

National Provider Directory
Tax ID family
One Alkaline Life2 organizations share this tax ID, including this one

Other organizations with this tax ID 1

Organizations that report the same tax identification number in the National Provider Directory.

Locations

1036 Saint Nicholas Dr
Unit 102
Waldorf, MD 20603
Phone (410) 934-0580

Practitioners & affiliated clinicians

Practitioners 13

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

View all 13

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1645574400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1751932800000",
    "number": "1104572775",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1036 SAINT NICHOLAS DR UNIT 102",
            "city": "WALDORF",
            "state": "MD",
            "postal_code": "206034758",
            "telephone_number": "410-934-0580",
            "fax_number": "410-834-1217"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1036 SAINT NICHOLAS DR UNIT 102",
            "city": "WALDORF",
            "state": "MD",
            "postal_code": "206034758",
            "telephone_number": "410-934-0580",
            "fax_number": "410-834-1217"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "ONE ALKALINE LIFE, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2022-02-23",
        "last_updated": "2025-07-08",
        "certification_date": "2025-07-08",
        "status": "A",
        "authorized_official_last_name": "STEVENS",
        "authorized_official_first_name": "LESTER",
        "authorized_official_title_or_position": "CEO",
        "authorized_official_telephone_number": "410-934-0581"
    },
    "taxonomies": [
        {
            "code": "101YM0800X",
            "taxonomy_group": "",
            "desc": "Counselor, Mental Health",
            "state": "NU",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "317218000",
            "state": "MD"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Waldorf, MD

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 8, 2025; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.