Provider Demographics
NPI:1033737838
Name:HARBOR HOLISTIC HEALING, LLC
Entity Type:Organization
Organization Name:HARBOR HOLISTIC HEALING, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/ACUPUNCTURIST
Authorized Official - Prefix:
Authorized Official - First Name:LYDIA
Authorized Official - Middle Name:ELLEN
Authorized Official - Last Name:WAINWRIGHT
Authorized Official - Suffix:
Authorized Official - Credentials:MAC, LICAC
Authorized Official - Phone:443-474-3631
Mailing Address - Street 1:85 TWO RIVERS DR
Mailing Address - Street 2:
Mailing Address - City:EDGEWATER
Mailing Address - State:MD
Mailing Address - Zip Code:21037-2677
Mailing Address - Country:US
Mailing Address - Phone:410-855-3144
Mailing Address - Fax:410-874-0131
Practice Address - Street 1:86 KENNEDY DR
Practice Address - Street 2:
Practice Address - City:SEVERNA PARK
Practice Address - State:MD
Practice Address - Zip Code:21146-3008
Practice Address - Country:US
Practice Address - Phone:443-474-3631
Practice Address - Fax:410-874-0131
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-07-08
Last Update Date:2020-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QH0100XAmbulatory Health Care FacilitiesClinic/CenterHealth Service