Provider Demographics
NPI:1548920697
Name:MARYLAND WELLNESS AND PSYCHIATRY LLC
Entity type:Organization
Organization Name:MARYLAND WELLNESS AND PSYCHIATRY LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:BILLING MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:LANCE
Authorized Official - Middle Name:
Authorized Official - Last Name:CONDA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:410-927-3510
Mailing Address - Street 1:2717 FRIENDSHIP FARM CT
Mailing Address - Street 2:
Mailing Address - City:WEST FRIENDSHIP
Mailing Address - State:MD
Mailing Address - Zip Code:21794-9310
Mailing Address - Country:US
Mailing Address - Phone:410-888-0731
Mailing Address - Fax:
Practice Address - Street 1:915 TOLL HOUSE AVE STE 209
Practice Address - Street 2:
Practice Address - City:FREDERICK
Practice Address - State:MD
Practice Address - Zip Code:21701-5901
Practice Address - Country:US
Practice Address - Phone:410-888-0731
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-12-29
Last Update Date:2025-05-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental HealthGroup - Multi-Specialty
No261QM1300XAmbulatory Health Care FacilitiesClinic/CenterMulti-Specialty