YOUR WELLNESS SOURCES - NPI 1114420320 - Dietitian, Registered in Hyattsville, MD

Q: What is Wellness Source LLC's NPI number?

The NPI number for Wellness Source LLC is 1114420320. It was assigned to this organization in the NPPES registry on March 14, 2018. The provider is doing business as Your Wellness Sources.

Q: What is Wellness Source LLC's specialty?

The primary specialty registered for this NPI is Dietitian, Registered with taxonomy code 133V00000X.

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About Your Wellness Sources NPPES

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

YOUR WELLNESS SOURCES (NPI 1114420320) is a healthcare organization registered as a dietitian, registered in Hyattsville, Maryland and active in the NPI registry since March 2018. The organization holds a CLIA Waiver certificate valid through May 15, 2027 and lists Marshalee George, Medical Director, as its authorized official.

NPPES Registry Identity

NPI1114420320

Entity TypeOrganization

Primary Taxonomy133V00000X

Legal Business NameWELLNESS SOURCE LLC

Location Address4301 GARDEN CITY DR STE 304Hyattsville, MD 20785-6105

Mailing Address4301 Garden City Dr Ste 304Hyattsville, MD 20785-6105 · (301) 235-0060

Phone(301) 235-0060

Organization SubpartNo

Authorized OfficialMarshalee GeorgeMedical Director · (301) 235-0060

Enumeration DateMarch 14, 2018

Last NPPES UpdateMay 4, 20222 updates tracked since enumeration

NPPES CertifiedMay 4, 2022

✔ NPI 1114420320 is a valid, active identifier and passes the ISO check-digit test.

Specialties & Licenses 10

★ Primary SpecialtyDietitian, RegisteredDietary & Nutritional Service Providers

Taxonomy Code133V00000X

Definition

A Registered Dietitian (RD)/Registered Dietitian Nutritionist (RDN) is an individual uniquely trained in the science of nutrition and practice of dietetics to design and provide medical nutrition therapy (MNT) and other evidence-based applications of the Nutrition Care Process (NCP) that exemplify the profession's systematic approach to providing high quality nutrition care. Registered dietitians provide MNT for the purpose of disease prevention or management, or to treat or rehabilitate an illness, injury, or condition, with the use of specific, indicated physical and cognitive nutrition care services comprised of one or more of the following aspects of the NCP: nutrition assessment/reassessment, nutrition diagnosis, nutrition intervention (e.g., nutrition counseling, therapeutic diet ordering, and nutrition education) and nutrition monitoring and evaluation.

Also ListedDietitian, Registered · Nutrition, MetabolicTaxonomy 133VN1006X

Also ListedDietitian, Registered · Nutrition, Obesity and Weight ManagementTaxonomy 133VN1201X

Also ListedRegistered Nurse · Psychiatric/Mental Health, Child & AdolescentTaxonomy 163WP0807X

Also ListedRegistered Nurse · Psychiatric/Mental HealthTaxonomy 163WP0808X

Also ListedInternal Medicine · Addiction MedicineTaxonomy 207RA0401X

Also ListedNurse Practitioner · Adult HealthTaxonomy 363LA2200X

Also ListedNurse Practitioner · FamilyTaxonomy 363LF0000X

Also ListedNurse Practitioner · Psychiatric/Mental HealthTaxonomy 363LP0808X

Also ListedNurse Practitioner · Women's HealthTaxonomy 363LW0102X

4301 GARDEN CITY DR STE 304, Hyattsville, MD 20785

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Other Names 1

Doing Business AsYour Wellness Sources

Group Practice 1

Group TaxonomyThis provider is a business group of one or more individual practitioners, who practice with different areas of specialization.193200000X MULTI-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 21D2130720

Wellness Source LLC · Hyattsville, MD

Active · expires May 15, 2027

CLIA Number21D2130720

Laboratory TypePractitioner Other

Certificate Effective DateMay 16, 2025

Certificate Expiration DateMay 15, 2027

Laboratory DirectorMarshalee George

Laboratory Phone(301) 235-0060

Laboratory LocationWellness Source LLC4301 Garden City Drive Suite 304, Hyattsville, MD 20785

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 10

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

KORDAI I DECOTEAU DPM

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