COMMUNITY WELLNESS OUTPATIENT MENTAL HEALTH CENTER LLC
Complete NPI Record 1114348463
Clinic/Center - Mental Health (Including Community Mental Health Center) in Baltimore, MD

Active since January 03, 2014

3310 EASTERN AVE FL 1, BALTIMORE, MD 21224(667) 309-9920(667) 309-9920 Get Directions

NPPES record last updated: March 17, 2026. Verified against the NPPES registry weekly; last sync: July 19, 2026.

Record update history: Mar 17, 2026, Jul 12, 2025, Dec 25, 2024 and 7 more (10 updates tracked since 2016).

Complete NPI Dataset

This page contains the complete raw NPPES record for Community Wellness Outpatient Mental Health Center Llc (NPI 1114348463), a clinic/center organization in Baltimore, MD. All 41 fields on file are listed with their current values and official NPPES definitions, exactly as recorded in the National Plan and Provider Enumeration System. Only fields that contain data are included, so the number of fields shown varies from one NPI record to another.

Use the tools below to filter fields by category, search within the record, or jump straight to a specific field. You can download the full record as a CSV, JSON, or text file, or filter first and export only the fields you need. The Print Clean Summary button produces a printer-friendly copy of the record.

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NPI: 1114348463: The 10-position all-numeric identification number assigned by the NPS to uniquely identify a health care provider. The NPI number includes an ISO standard check-digit in the 10th position. There is no intelligence about the health care provider in the number.
Entity Type Code: 2: Code describing the type of health care provider that is being assigned an NPI. Codes are 1 = (Person): individual human being who furnishes health care; 2 = (Non-person): entity other than an individual human being that furnishes health care (for example, hospital, SNF, hospital subunit, pharmacy, or HMO).
Employer Identification Number EIN: Not available: The Employer Identification Number (EIN), assigned by the IRS, of the provider being identified.
Provider Organization Name Legal Business Name: COMMUNITY WELLNESS OUTPATIENT MENTAL HEALTH CENTER LLC: The name of the organization provider. If the provider is an organization, this is the legal business name.
Provider Other Organization Name: Not available: Other name by which the organization provider is or has been known.
Provider Other Organization Name Type Code: 6: Code identifying the type of other name. Codes are: 1 = former name; 2 = professional name; 3 = doing business as (d/b/ a) name; 4 = former legal business name; 5 = other.
Provider First Line Business Mailing Address: 3310 EASTERN AVE: The first line mailing address of the provider being identified. This data element may contain the same information as "Provider first line location address".
Provider Business Mailing Address City Name: BALTIMORE: The city name in the mailing address of the provider being identified.
Provider Business Mailing Address State Name: MD: The State or Province name in the mailing address of the provider being identified. This data element may contain the same information as "Provider location address State name".
Provider Business Mailing Address Postal Code: 212244108: The postal ZIP or zone code in the mailing address of the provider being identified. NOTE: ZIP code plus 4-digit extension, if available. This data element may contain the same information as "Provider location address postal code".
Provider Business Mailing Address Country Code If outside U S : US: The country code in the mailing address of the provider being identified. This data element may contain the same information as "Provider location address country code".
Provider Business Mailing Address Telephone Number: 6673099920: The telephone number associated with mailing address of the provider being identified. This data element may contain the same information as "Provider location address telephone number".
Provider First Line Business Practice Location Address: 3310 EASTERN AVE FL 1: The first line location address of the provider being identified. For providers with more than one physical location, this is the primary location. This address cannot include a Post Office box.
Provider Business Practice Location Address City Name: BALTIMORE: The city name in the location address of the provider being identified.
Provider Business Practice Location Address State Name: MD: The State code in the location of the provider being identified.
Provider Business Practice Location Address Postal Code: 212244108: The postal ZIP or zone code in the location address of the provider being identified. NOTE: ZIP code plus 4-digit extension, if available.
Provider Business Practice Location Address Country Code If outside U S : US: The country code in the location address of the provider being identified.
Provider Business Practice Location Address Telephone Number: 6673099920: The telephone number associated with the location address of the provider being identified.
Provider Business Practice Location Address Fax Number: 6673099920: The fax number associated with the location address of the provider being identified.
Provider Enumeration Date: 1/3/2014: The date the provider was assigned a unique identifier (assigned an NPI).
Last Update Date: 3/17/2026: The date that a record was last updated or changed.
Authorized Official Last Name: HOLMES: The last name of the person authorized to submit the NPI application or to change NPS data for a health care provider.
Authorized Official First Name: VERNON: The first name of the authorized official.
Authorized Official Title or Position: CEO: The title or position of the authorized official.
Authorized Official Telephone Number: 6673099920: The 10-position telephone number of the authorized official.
Healthcare Provider Taxonomy Code 1: 261QM0801X: This field represents the provider's taxonomy code, which classifies their type, classification, and area of specialization. This code comes from the Healthcare Provider Taxonomy Code Set maintained by the National Uniform Claim Committee (NUCC). The NPS will associate these data with the license data for providers with Entity type code = 1.
Healthcare Provider Primary Taxonomy Switch 1: Y: This field shows whether the related taxonomy code is the provider's primary specialty. It is a single-character value: "Y" indicates the taxonomy is the primary one, while "N" indicates it is not. Each provider record can have only one taxonomy code marked as primary.
Other Provider Identifier 1: 180702672: An additional identifier number for the provider, either current or previously used. This may include IDs issued by health plans, state agencies, or other organizations. The value is collected from the NPI application or update form.
Other Provider Identifier Type Code 1: 01: A code that specifies the type of additional identifier associated with the provider, either current or past. Examples include UPIN (Universal Provider Identification Number), NSC (National Supplier Clearinghouse), OSCAR (CMS Certification Number), DEA (Drug Enforcement Administration number), state Medicaid ID, or a plan-specific PIN. The value is collected from the NPI application or update form.
Other Provider Identifier State 1: MD: The two-letter state code representing the U.S. state or territory that issued the additional provider identifier. This links the Other Provider Identifier to the state where it is valid or was assigned.
Other Provider Identifier Issuer 1: MARYLAND DEPARTMENT OF HEALTH BEHAVIORAL HEALTH ADMINISTRATION: The name of the organization, agency, or health plan that assigned the additional provider identifier. This identifies who issued the number linked to Other Provider Identifier 1 (for example, a state Medicaid agency, Medicare, or a private insurance company).
Other Provider Identifier 2: 424340400: An additional identifier number for the provider, either current or previously used. This may include IDs issued by health plans, state agencies, or other organizations. The value is collected from the NPI application or update form.
Other Provider Identifier Type Code 2: 05: A code that specifies the type of additional identifier associated with the provider, either current or past. Examples include UPIN (Universal Provider Identification Number), NSC (National Supplier Clearinghouse), OSCAR (CMS Certification Number), DEA (Drug Enforcement Administration number), state Medicaid ID, or a plan-specific PIN. The value is collected from the NPI application or update form.
Other Provider Identifier State 2: MD: The two-letter state code representing the U.S. state or territory that issued the additional provider identifier. This links the Other Provider Identifier to the state where it is valid or was assigned.
Is Organization Subpart: Y: Indicates whether the provider is a subpart of a larger organization. This is a single-character code: "Y" means the entity is an organizational subpart, while "N" means it is not. Subparts typically include hospital departments, clinics, or other distinct units that fall under a parent organization.
Parent Organization LBN: FREEDOM HEALTHCARE LLC: The Legal Business Name (LBN) of the parent organization, if the provider is a subpart of a larger entity. This field identifies the official registered name of the parent company or organization under which the provider operates.
Parent Organization TIN: Not available: The Taxpayer Identification Number (TIN) of the parent organization, provided when the provider is a subpart of a larger entity. This field identifies the federal tax ID used by the parent organization for official and billing purposes.
Authorized Official Name Prefix Text: MR.: The prefix used in the name of the authorized official associated with the provider's NPI record. Examples include Mr., Ms., Mrs., Dr., or other common professional or personal prefixes.
Authorized Official Name Suffix Text: JR.: The suffix used in the name of the authorized official associated with the provider's NPI record. Examples include Jr., Sr., II, III, or professional designations such as PhD, MD, or Esq.
Authorized Official Credential Text: MBA: The professional credential(s) of the authorized official listed on the provider's NPI record. Examples include MD (Doctor of Medicine), DO (Doctor of Osteopathy), RN (Registered Nurse), DDS (Doctor of Dental Surgery), PhD, or other recognized designations that reflect the official's qualifications.
NPI Certification Date: 3/17/2026: The date on which the National Provider Identifier (NPI) was officially assigned and certified to the provider. This reflects when the provider's NPI record first became active in the NPPES system.

Other Organization Names 2

Additional business and trade names this provider has on file with the NPPES registry.

Community Wellness Center Doing Business As

1/2

Doing Business As: A trade name or operating name under which an organization provides services, distinct from its registered legal business name.

Community Wellness Outpatient Mental Health Center Doing Business As

2/2

Doing Business As: A trade name or operating name under which an organization provides services, distinct from its registered legal business name.

Secondary Practice Locations 32

The first line of the secondary practice location address of the provider being identified. For providers with more than one physical location, this is a secondary practice location address. This address cannot include a Post Office box.

3415 Holmes Ave Apt 1

1/32

Baltimore, MD 21217-2067 · Phone (443) 708-5056

116 W Main St Ste 401

2/32

Salisbury, MD 21801-4905 · Phone (667) 309-9920

5517 Ritchie Hwy Ste A

3/32

Brooklyn Park, MD 21225-3457 · Phone (667) 309-9920

820 Stone Ave

4/32

Waldorf, MD 20602-2844 · Phone (667) 309-9920

819 N Fremont Ave Fl 2

5/32

Baltimore, MD 21217-2552 · Phone (443) 708-5056

3007 Rayner Ave Ofc

6/32

Baltimore, MD 21216-4612 · Phone (443) 708-5056

1450 Montpelier St Ofc

7/32

Baltimore, MD 21218-4852 · Phone (443) 387-3819

1638 Ruxton Ave Ofc

8/32

Baltimore, MD 21216-3715 · Phone (443) 708-0602

1820 Spence St Ofc

9/32

Baltimore, MD 21230-1351 · Phone (443) 708-5056

2670 Kennedy Ave Ofc

10/32

Baltimore, MD 21218-4967 · Phone (410) 624-7602 · Fax (410) 624-7607

30936 Manchester Ln

11/32

Laurel, DE 19956-3588 · Phone (443) 783-4897

8390 Indian Head Hwy Apt C2

12/32

Fort Washington, MD 20744-4549 · Phone (301) 485-8446

8360 Indian Head Hwy Apt A1

13/32

Fort Washington, MD 20744-4521 · Phone (301) 485-8446

809 N Rose St Ofc

14/32

Baltimore, MD 21205-1615 · Phone (667) 930-3924

25709 Porter Mill Rd

15/32

Hebron, MD 21830-1009 · Phone (443) 783-4897

5515 Park St

16/32

Chevy Chase, MD 20815-7108 · Phone (301) 801-0787

4301 Military Rd NW

17/32

Washington, DC 20015-2136 · Phone (301) 801-0787

908 Valley St Apt 13

18/32

Baltimore, MD 21202-5458 · Phone (667) 210-6153

8402 Indian Head Hwy Apt C1

19/32

Fort Washington, MD 20744-4530 · Phone (240) 766-4225

912 Mentor Ave Ofc

20/32

Capitol Heights, MD 20743-4051 · Phone (202) 716-8287

925 N Broadway Ofc

21/32

Baltimore, MD 21205-1129 · Phone (443) 708-5056

8428 Indian Head Hwy Apt B1

22/32

Fort Washington, MD 20744-4533 · Phone (301) 485-8568

1119 E Monument St

23/32

Baltimore, MD 21202-4119 · Phone (443) 873-7792

3021 Garrison Blvd

24/32

Baltimore, MD 21216-2070 · Phone (667) 309-9920

9808 Tribonian Dr Lowr Level

25/32

Fort Washington, MD 20744-5422 · Phone (301) 839-4248

1620 Druid Hill Ave

26/32

Baltimore, MD 21217-4960 · Phone (667) 309-9920

1116 E 20th St

27/32

Baltimore, MD 21218-6312 · Phone (667) 309-9920

1114 E 20th St

28/32

Baltimore, MD 21218-6312 · Phone (667) 309-9920

1723 Gwynns Falls Pkwy

29/32

Baltimore, MD 21217-2098 · Phone (667) 309-9920

2140 Druid Hill Ave

30/32

Baltimore, MD 21217-3236 · Phone (667) 309-9920

1649 Darley Ave

31/32

Baltimore, MD 21213-1318 · Phone (667) 309-9920

112 S Mount St

32/32

Baltimore, MD 21223-2768 · Phone (667) 309-9920

Other Provider Identifiers 2

Legacy and payer-issued identifiers reported to the NPPES registry for this provider.

180702672 Other

1/2

State: MD · Issuer: Maryland Department Of Health Behavioral Health Administration
Other: An additional provider identifier that does not correspond to any of the other defined identifier type categories.

424340400 Medicaid

2/2

State: MD
Medicaid (State-specific): A provider identification number assigned by an individual state's Medicaid program, used for billing and enrollment within that state's Medicaid system.

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