Provider Demographics
NPI:1326721002
Name:HOLISTIC HEALING THERAPY LLC
Entity Type:Organization
Organization Name:HOLISTIC HEALING THERAPY LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CLINICAL SOCIAL WORKER
Authorized Official - Prefix:
Authorized Official - First Name:FATME
Authorized Official - Middle Name:
Authorized Official - Last Name:ANCOUNI
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:313-414-3093
Mailing Address - Street 1:6642 THEISEN ST
Mailing Address - Street 2:
Mailing Address - City:DEARBORN
Mailing Address - State:MI
Mailing Address - Zip Code:48126-1984
Mailing Address - Country:US
Mailing Address - Phone:313-414-3093
Mailing Address - Fax:
Practice Address - Street 1:6642 THEISEN ST
Practice Address - Street 2:
Practice Address - City:DEARBORN
Practice Address - State:MI
Practice Address - Zip Code:48126-1984
Practice Address - Country:US
Practice Address - Phone:313-414-3093
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-08-09
Last Update Date:2023-08-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0850XAmbulatory Health Care FacilitiesClinic/CenterAdult Mental Health