Provider Demographics
NPI:1376824730
Name:HOLISTIC SERVICES INC
Entity Type:Organization
Organization Name:HOLISTIC SERVICES INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:KIA
Authorized Official - Middle Name:
Authorized Official - Last Name:MCLEAN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:336-258-1532
Mailing Address - Street 1:1405 YANCEYVILLE ST
Mailing Address - Street 2:SUITE E
Mailing Address - City:GREENSBORO
Mailing Address - State:NC
Mailing Address - Zip Code:27405-6938
Mailing Address - Country:US
Mailing Address - Phone:336-333-2559
Mailing Address - Fax:336-333-2578
Practice Address - Street 1:1405 YANCEYVILLE ST
Practice Address - Street 2:SUITE E
Practice Address - City:GREENSBORO
Practice Address - State:NC
Practice Address - Zip Code:27405-6938
Practice Address - Country:US
Practice Address - Phone:336-333-2559
Practice Address - Fax:336-333-2578
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-08-30
Last Update Date:2011-08-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCMHL-041-1041251S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC8303156Medicaid