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LIFES ENERGY WELLNESS CENTER INC.

Behavioral Health & Social Service Providers Social Worker Clinical

Provider NPI: 1053800110

Organization Information:
Organization Name:  LIFES ENERGY WELLNESS CENTER INC.
Organization is not Subpart
Authorized Official:  ANDREA  KELLEY-FREEMAN, M.S., LCADC, LGPC,  CEO  800-867-2395

Practice Location:
514 POPLAR ST  CAMBRIDGE, MD 21613-1834 US
Tel: 800-867-2395  Fax: --

Business Mailing Address:
PO BOX 123  EASTON, MD 21601-8901 US
Tel: 800-867-2395  Fax: --

NPI Information:
NPI: 1053800110
Entity Type: Organization

Taxonomy:

PrimaryCodeCategory/DescriptionStateLicense Number
N1041C0700XBehavioral Health & Social Service Providers
Social Worker
Clinical
N163WA0400XNursing Service Providers
Registered Nurse
N163WH0200XNursing Service Providers
Registered Nurse
N103TA0400XBehavioral Health & Social Service Providers
Psychologist
N163WP0809XNursing Service Providers
Registered Nurse
N163WP0808XNursing Service Providers
Registered Nurse
N207QA0401XPhysicians
Family Medicine
N2084P0800XPhysicians
Psychiatry & Neurology
N2084P0802XPhysicians
Psychiatry & Neurology
N261QR1300XAmbulatory Health Care Facilities
Clinic/Center
Y101YA0400XBehavioral Health & Social Service Providers
Counselor
N363LP0808XPhysician Assistants & Advanced Practice Nursing Providers
Nurse Practitioner

Other Provider Identifiers:

IssuerNumberStateType



American Medical Association 2012 taxonomy code information

Code: 101YA0400X

Type:

Classification:



Definition:



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