Provider Demographics
NPI:1043968449
Name:AVENEL HOLISTIC HEALTH SERVICES LLC
Entity Type:Organization
Organization Name:AVENEL HOLISTIC HEALTH SERVICES LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:MRS
Authorized Official - First Name:NWAMAKA
Authorized Official - Middle Name:STEPHANIE
Authorized Official - Last Name:OBIESIE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:240-451-8300
Mailing Address - Street 1:1300 MERCANTILE LN STE 142
Mailing Address - Street 2:
Mailing Address - City:LARGO
Mailing Address - State:MD
Mailing Address - Zip Code:20774-5331
Mailing Address - Country:US
Mailing Address - Phone:240-451-8300
Mailing Address - Fax:240-451-8305
Practice Address - Street 1:1300 MERCANTILE LN STE 142
Practice Address - Street 2:
Practice Address - City:LARGO
Practice Address - State:MD
Practice Address - Zip Code:20774-5331
Practice Address - Country:US
Practice Address - Phone:240-451-8300
Practice Address - Fax:240-451-8305
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-03-15
Last Update Date:2022-03-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0801XAmbulatory Health Care FacilitiesClinic/CenterMental Health (Including Community Mental Health Center)
No261QM0850XAmbulatory Health Care FacilitiesClinic/CenterAdult Mental Health
No261QM0855XAmbulatory Health Care FacilitiesClinic/CenterAdolescent and Children Mental Health