Provider Demographics
NPI:1144579947
Name:WHOLE LIFE SERVICES
Entity Type:Organization
Organization Name:WHOLE LIFE SERVICES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MRS
Authorized Official - First Name:RANDI
Authorized Official - Middle Name:DIANE
Authorized Official - Last Name:HADDOCK
Authorized Official - Suffix:
Authorized Official - Credentials:LCSW
Authorized Official - Phone:479-925-0122
Mailing Address - Street 1:4008 KISNER CIR
Mailing Address - Street 2:
Mailing Address - City:SPRINGDALE
Mailing Address - State:AR
Mailing Address - Zip Code:72762-6618
Mailing Address - Country:US
Mailing Address - Phone:479-925-0122
Mailing Address - Fax:
Practice Address - Street 1:4008 KISNER CIR
Practice Address - Street 2:
Practice Address - City:SPRINGDALE
Practice Address - State:AR
Practice Address - Zip Code:72762-6618
Practice Address - Country:US
Practice Address - Phone:479-925-0122
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-09-07
Last Update Date:2012-09-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Single Specialty