Provider Demographics
NPI:1871948877
Name:HEALING OAK WELLNESS CENTER, LLC
Entity type:Organization
Organization Name:HEALING OAK WELLNESS CENTER, LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:CLINICAL PSYCHOLOGIST
Authorized Official - Prefix:DR
Authorized Official - First Name:JOHN
Authorized Official - Middle Name:BURKE
Authorized Official - Last Name:MEALY
Authorized Official - Suffix:
Authorized Official - Credentials:PHD
Authorized Official - Phone:301-258-3418
Mailing Address - Street 1:15817 CRABBS BRANCH WAY
Mailing Address - Street 2:
Mailing Address - City:ROCKVILLE
Mailing Address - State:MD
Mailing Address - Zip Code:20855-6613
Mailing Address - Country:US
Mailing Address - Phone:301-258-3418
Mailing Address - Fax:301-258-3419
Practice Address - Street 1:15817 CRABBS BRANCH WAY
Practice Address - Street 2:
Practice Address - City:ROCKVILLE
Practice Address - State:MD
Practice Address - Zip Code:20855-6613
Practice Address - Country:US
Practice Address - Phone:301-258-3418
Practice Address - Fax:301-258-3419
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-04-27
Last Update Date:2016-04-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD702103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinicalGroup - Multi-Specialty