NPIMap

Organization Active NPI

Addiction Wellness Center LLC

  • Adult Health Nurse Practitioner
  • Quantico, MD
National Provider Identifier
1912760877
Registry record updated Feb 28, 2025
On this page

Key facts

NPPES NPI Registry
Primary specialty
Adult Health Nurse PractitionerTaxonomy code 363LA2200X
Legal business name
ADDICTION WELLNESS CENTER LLC
Practice address
5438 Sandy Hill Rd Ste a
Quantico, MD 21856-2100
Phone
(443) 547-2964
NPI assigned
Feb 2, 2024
Last updated
Feb 28, 2025By the provider in NPPES
Organization subpart
Yes
Parent organization
ADDICTION WELLNESS CENTER LLCAs reported in NPPES

NPPES NPI Registry

Updated by the provider on Feb 28, 2025

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

Authorized official

Name
Jessie Costley
Title
Credentialing Specialist
Phone
(443) 839-6928

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Adult Health Nurse Practitioner 363LA2200X Primary

Addresses

Primary practice location

5438 Sandy Hill Rd Ste a
Quantico, MD 21856-2100

Mailing address

5438 Sandy Hill Rd Ste a
Quantico, MD 21856-2100
Phone (443) 547-2964

Other identifiers 1

IdentifierTypeStateIssuer
213477200MedicaidMD

National Provider Directory

National Provider Directory
Tax ID family
Addiction Wellness Center LLC2 organizations share this tax ID, including this one
Part of
Addiction Wellness Center LLC

Other organizations with this tax ID 1

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

Locations

5438 Sandy Hill Rd
Ste A
Quantico, MD 21856
Phone (443) 547-2964

Ownership & related parties

Parent organization (reported in NPPES) 1

This organization reports itself as a subpart in NPPES; the parent’s legal name matches this organization in the same state.

Practitioners & affiliated clinicians

Practitioners 4

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.

NPI Registry JSON

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

{
    "created_epoch": "1706832000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1740700800000",
    "number": "1912760877",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "5438 SANDY HILL RD STE A",
            "city": "QUANTICO",
            "state": "MD",
            "postal_code": "218562100",
            "telephone_number": "443-547-2964"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "5438 SANDY HILL RD STE A",
            "city": "QUANTICO",
            "state": "MD",
            "postal_code": "218562100",
            "telephone_number": "443-547-2964"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "ADDICTION WELLNESS CENTER LLC",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "ADDICTION WELLNESS CENTER LLC",
        "enumeration_date": "2024-02-02",
        "last_updated": "2025-02-28",
        "certification_date": "2025-02-28",
        "status": "A",
        "authorized_official_last_name": "COSTLEY",
        "authorized_official_first_name": "JESSIE",
        "authorized_official_title_or_position": "CREDENTIALING SPECIALIST",
        "authorized_official_telephone_number": "443-839-6928"
    },
    "taxonomies": [
        {
            "code": "363LA2200X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Adult Health",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "213477200",
            "state": "MD"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Quantico, MD

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 28, 2025; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.