OrganizationActive
Addiction Wellness Center LLC
NPI 1912760877 · Adult Health Nurse Practitioner · Quantico, MD
Provider details
- NPI number
- 1912760877
- Entity type
- Organization
- Primary specialty
- Adult Health Nurse PractitionerPhysician Assistants & Advanced Practice Nursing Providers
- Parent organization
- Addiction Wellness Center LLC
- Organization subpart
- Yes
- Authorized official
- Jessie Costley, Credentialing Specialist(443) 839-6928
Specialties & taxonomies
Physician Assistants & Advanced Practice Nursing Providers
Practice location
5438 Sandy Hill Rd Ste a
Quantico, MD 21856-2100
Phone: (443) 547-2964
Approximate (ZIP-level) locationGet directions
Mailing address
5438 Sandy Hill Rd Ste a
Quantico, MD 21856-2100
Registry dates
- Enumerated
- 2024-02-02
- Last updated
- 2025-02-28
- Certified
- 2025-02-28
Source: CMS NPPES Data Dissemination (June 2026). NPI Central is not affiliated with CMS. Data is provided as-is from the public registry.