Provider Demographics
NPI:1003176538
Name:HOLISTIC THERAPIES & CONSULTING
Entity Type:Organization
Organization Name:HOLISTIC THERAPIES & CONSULTING
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:AMY
Authorized Official - Middle Name:SCHUMANN
Authorized Official - Last Name:LASSETER
Authorized Official - Suffix:
Authorized Official - Credentials:LPC
Authorized Official - Phone:706-307-2780
Mailing Address - Street 1:1 HUNTINGTON RD STE 105
Mailing Address - Street 2:
Mailing Address - City:ATHENS
Mailing Address - State:GA
Mailing Address - Zip Code:30606-7205
Mailing Address - Country:US
Mailing Address - Phone:888-307-2780
Mailing Address - Fax:
Practice Address - Street 1:1 HUNTINGTON RD STE 105
Practice Address - Street 2:
Practice Address - City:ATHENS
Practice Address - State:GA
Practice Address - Zip Code:30606-7205
Practice Address - Country:US
Practice Address - Phone:888-307-2780
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-05-17
Last Update Date:2012-05-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GALPC006359251S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA003122013AMedicaid