Provider Demographics
NPI:1679101976
Name:ADVANCED PSYCHIATRIC WELLNESS CENTER LLC
Entity type:Organization
Organization Name:ADVANCED PSYCHIATRIC WELLNESS CENTER LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/NURSE PRACTITIONER
Authorized Official - Prefix:
Authorized Official - First Name:VERONICA
Authorized Official - Middle Name:
Authorized Official - Last Name:MORTON
Authorized Official - Suffix:
Authorized Official - Credentials:APRN
Authorized Official - Phone:240-403-4068
Mailing Address - Street 1:PO BOX 3635
Mailing Address - Street 2:
Mailing Address - City:FREDERICK
Mailing Address - State:MD
Mailing Address - Zip Code:21705-3635
Mailing Address - Country:US
Mailing Address - Phone:240-403-4068
Mailing Address - Fax:240-238-6084
Practice Address - Street 1:1 RESEARCH CT STE 450
Practice Address - Street 2:
Practice Address - City:ROCKVILLE
Practice Address - State:MD
Practice Address - Zip Code:20850-6252
Practice Address - Country:US
Practice Address - Phone:240-403-4068
Practice Address - Fax:240-238-6084
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-03-31
Last Update Date:2021-06-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatryGroup - Single Specialty