Provider Demographics
NPI:1366043671
Name:HOLISTICALLY YOU THERAPEUTIC SERVICES, LLC
Entity Type:Organization
Organization Name:HOLISTICALLY YOU THERAPEUTIC SERVICES, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:JO ANN
Authorized Official - Middle Name:MCMILLAN
Authorized Official - Last Name:HARRIS
Authorized Official - Suffix:
Authorized Official - Credentials:LCSW
Authorized Official - Phone:703-774-6542
Mailing Address - Street 1:2227 OLD BRIDGE RD UNIT 221
Mailing Address - Street 2:
Mailing Address - City:WOODBRIDGE
Mailing Address - State:VA
Mailing Address - Zip Code:22192-3007
Mailing Address - Country:US
Mailing Address - Phone:703-774-6542
Mailing Address - Fax:
Practice Address - Street 1:2227 OLD BRIDGE RD UNIT 221
Practice Address - Street 2:
Practice Address - City:WOODBRIDGE
Practice Address - State:VA
Practice Address - Zip Code:22192-3007
Practice Address - Country:US
Practice Address - Phone:703-774-6542
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-11-03
Last Update Date:2020-11-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Single Specialty