Provider Demographics
NPI:1093250474
Name:HOLISTIC, RE-EDUCATION, & EMPOWERING SERICES, LLC
Entity Type:Organization
Organization Name:HOLISTIC, RE-EDUCATION, & EMPOWERING SERICES, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER, MENTAL HEALTH THERAPIST
Authorized Official - Prefix:MRS
Authorized Official - First Name:TRACY
Authorized Official - Middle Name:D
Authorized Official - Last Name:DAVIS
Authorized Official - Suffix:
Authorized Official - Credentials:LCPC
Authorized Official - Phone:202-540-0718
Mailing Address - Street 1:2305 FAIRHAVEN LANE
Mailing Address - Street 2:
Mailing Address - City:CROFTON
Mailing Address - State:MD
Mailing Address - Zip Code:21114
Mailing Address - Country:US
Mailing Address - Phone:202-540-0718
Mailing Address - Fax:
Practice Address - Street 1:2305 FAIRHAVEN LANE
Practice Address - Street 2:
Practice Address - City:CROFTON
Practice Address - State:MD
Practice Address - Zip Code:21114
Practice Address - Country:US
Practice Address - Phone:202-540-0718
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-12-21
Last Update Date:2016-12-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDLC7042251S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health