Provider Demographics
NPI:1174946271
Name:GIFTED HANDS WELLNESS CENTER, LLC
Entity type:Organization
Organization Name:GIFTED HANDS WELLNESS CENTER, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MRS
Authorized Official - First Name:NICOLE
Authorized Official - Middle Name:S
Authorized Official - Last Name:WRIGHT
Authorized Official - Suffix:
Authorized Official - Credentials:LICSW, LCSW-C
Authorized Official - Phone:301-202-4814
Mailing Address - Street 1:12210 MAYCHECK LN
Mailing Address - Street 2:
Mailing Address - City:BOWIE
Mailing Address - State:MD
Mailing Address - Zip Code:20715-1555
Mailing Address - Country:US
Mailing Address - Phone:301-202-4814
Mailing Address - Fax:
Practice Address - Street 1:5900 PRINCESS GARDEN PKWY
Practice Address - Street 2:SUITE 670
Practice Address - City:LANHAM
Practice Address - State:MD
Practice Address - Zip Code:20706-2925
Practice Address - Country:US
Practice Address - Phone:301-202-4814
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-01-24
Last Update Date:2016-01-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD179161041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD265114900Medicaid