Provider Demographics
NPI:1407576069
Name:HOLISTIC WELLNESS COUNSELING LLC
Entity Type:Organization
Organization Name:HOLISTIC WELLNESS COUNSELING LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:BILLING/CREDENTIALING
Authorized Official - Prefix:
Authorized Official - First Name:MARIA
Authorized Official - Middle Name:
Authorized Official - Last Name:CIVITELLI-FORGIONE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:203-848-8305
Mailing Address - Street 1:426 WESTPORT AVE # 1022
Mailing Address - Street 2:
Mailing Address - City:NORWALK
Mailing Address - State:CT
Mailing Address - Zip Code:06851-4423
Mailing Address - Country:US
Mailing Address - Phone:203-848-8305
Mailing Address - Fax:
Practice Address - Street 1:102 E PEBBLE CT
Practice Address - Street 2:
Practice Address - City:JACKSONVILLE
Practice Address - State:NC
Practice Address - Zip Code:28546
Practice Address - Country:US
Practice Address - Phone:860-689-7125
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-09-01
Last Update Date:2022-09-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessionalGroup - Single Specialty