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MARYLAND WELLNESS LLC
NPI 1003479668
Clinic/Center - Mental Health (Including Community Mental Health Center) in Baltimore, MD

Active since April 19, 2019CLIA 21D2348287 · Waiver
4128 HAYWARD AVE # W, BALTIMORE, MD 21215(410) 994-6491 Get Directions Write a Review

NPPES record last updated: April 16, 2025. Verified against the NPPES registry weekly; last sync: September 20, 2026.

Record update history: Mar 7, 2023, Dec 7, 2022, Apr 29, 2021 and 3 more (6 updates tracked since 2019).

About Maryland Wellness Llc NPPES

Official registry information on file with the National Plan and Provider Enumeration System.

MARYLAND WELLNESS LLC (NPI 1003479668) is a healthcare organization registered as a mental health (including community mental health center) in Baltimore, Maryland and active in the NPI registry since April 2019. The organization holds a CLIA Waiver certificate valid through August 3, 2028, maintains 7 additional practice locations, and lists Sierra Burley, Credentialing Specialist, as its authorized official.

NPPES Registry Identity

NPI1003479668
Entity TypeOrganization
Primary Taxonomy261QM0801X
Legal Business NameMARYLAND WELLNESS LLC
Location Address4128 HAYWARD AVE # WBaltimore, MD 21215-4340
Mailing Address4128 Hayward Ave # WBaltimore, MD 21215-4340 · (410) 994-6491
Phone(410) 994-6491
Organization SubpartNo
Authorized OfficialSierra BurleyCredentialing Specialist · (410) 314-1030
Enumeration DateApril 19, 2019
Last NPPES UpdateApril 16, 20256 updates tracked since enumeration
NPPES CertifiedApril 16, 2025
✔ NPI 1003479668 is a valid, active identifier and passes the ISO check-digit test.

Specialties & Licenses 4

★ Primary SpecialtyClinic/Center · Mental Health (Including Community Mental Health Center)Ambulatory Health Care Facilities
Taxonomy Code261QM0801X
Also ListedPsychologist · Group PsychotherapyTaxonomy 103TP2701X
Also ListedCase ManagementTaxonomy 251B00000X
Also ListedClinic/Center · Rehabilitation, Substance Use DisorderTaxonomy 261QR0405X
4128 HAYWARD AVE # W, Baltimore, MD 21215
Open in Google Maps ↗

Secondary Practice Locations 7

Location 14500 Black Rock Rd # G2Hampstead, MD 21074-2636 · Phone (410) 241-6317
Location 2519 N Mechanic StCumberland, MD 21502-2133 · Phone (410) 241-6317
Location 3117 E Main StWestminster, MD 21157-5012 · Phone (410) 241-6317
Location 4920 W Washington St Ste 201Hagerstown, MD 21740-2803 · Phone (410) 241-6317
Location 54200 Forbes Blvd Ste 104Lanham, MD 20706-4872 · Phone (410) 241-6317
Location 68 Church Ln # WPikesville, MD 21208-3721 · Phone (410) 241-6317
Location 72255 Crain Hwy Ste 106Waldorf, MD 20601-3186 · Phone (410) 241-6317

Other Identifiers 6

Medicaid907713800MD
Other220412461MD · Maryland Behavioral Health Administration
Other220412462MD · Maryland Behavioral Health Administration
Other220412464MD · Maryland Behavioral Health Administration
Other220412460MD · Maryland Behavioral Health Administration
Other220412463MD · Maryland Behavioral Health Administration

Group Practice 1

Group TaxonomyThis provdier is a business group of one or more individual practitioners, all of who practice with the same area of specialization.193400000X MULTIPLE SINGLE SPECIALTY GROUP

CLIA Laboratory Certificates CMS CLIA

Laboratory certificates issued under the Clinical Laboratory Improvement Amendments (CLIA) program, which sets federal quality standards for human laboratory testing in the United States. There is no official CMS crosswalk between CLIA and NPI numbers; these certificates are associated with this NPI by matching facility names, locations and phone numbers in the CMS CLIA registry.

Certificate of Waiver 21D2348287

Maryland Wellness LLC · Baltimore, MD
Active · expires Aug 3, 2028
CLIA Number21D2348287
Laboratory TypeCommunity Clinic
Certificate Effective DateAugust 4, 2026
Certificate Expiration DateAugust 3, 2028
Laboratory DirectorJon Dsouza
Laboratory Phone(410) 314-1030
Laboratory LocationMaryland Wellness LLC4128 Hayward Avenue, Baltimore, MD 21215
CLIA data matches this NPI record on: Address Name Phone
This certificate is issued to a laboratory to perform only waived tests.

Other Providers at the Same Location NPPES 3

Providers registered at the same practice address, or within the immediate area, according to the NPPES registry.

MARYLAND WELLNESS LLC
Clinic/Center (Rehabilitation, Substance Use Disorder)
4128 HAYWARD AVE # W
BALTIMORE, MD 21215
Baltimore City (410) 314-1030
MARYLAND WELLNESS LLC
Clinic/Center (Rehabilitation)
4128 HAYWARD AVE # W
BALTIMORE, MD 21215
Baltimore City (410) 314-1030
MARYLAND WELLNESS LLC
Clinic/Center (Mental Health (Including Community Mental Health Center))
4128 HAYWARD AVE # W
BALTIMORE, MD 21215
Baltimore City (410) 314-1030

Frequently Asked Questions NPPES & CMS

Common questions about this NPI record, answered from the official NPPES registry and CMS datasets shown on this page.

What is Maryland Wellness LLC's NPI number?

The NPI number for Maryland Wellness LLC is 1003479668. It was assigned to this organization in the NPPES registry on April 19, 2019.

Where is Maryland Wellness LLC located?

Maryland Wellness LLC is located at 4128 Hayward Ave # W, Baltimore, MD 21215. The listed phone number is (410) 994-6491.

What is Maryland Wellness LLC's specialty?

The primary specialty registered for this NPI is Clinic/Center, specializing in Mental Health (Including Community Mental Health Center), with taxonomy code 261QM0801X.

Does Maryland Wellness LLC hold a CLIA laboratory certificate?

Yes. A Certificate of Waiver (number 21D2348287) is associated with this NPI, valid through August 3, 2028. CLIA certificates authorize laboratory testing under the federal Clinical Laboratory Improvement Amendments program.

When was this NPI record last updated?

The NPPES record for Maryland Wellness LLC was last updated on April 16, 2025. NPI Profile syncs weekly with the NPPES registry data releases published by CMS. This NPI record was last updated 17 months ago. If this record has changed at CMS more recently, you can request an on-demand re-check against the live CMS registry, directly from this page.