Provider Demographics
NPI:1467125104
Name:ETW THERAPEUTIC & HOLISTIC SERVICES LLC
Entity Type:Organization
Organization Name:ETW THERAPEUTIC & HOLISTIC SERVICES LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT/CEO
Authorized Official - Prefix:DR
Authorized Official - First Name:ERIC
Authorized Official - Middle Name:
Authorized Official - Last Name:WHITAKER
Authorized Official - Suffix:
Authorized Official - Credentials:PHD, LCSW-C, LICSW
Authorized Official - Phone:202-743-5660
Mailing Address - Street 1:10903 INDIAN HEAD HWY STE 404
Mailing Address - Street 2:
Mailing Address - City:FORT WASHINGTON
Mailing Address - State:MD
Mailing Address - Zip Code:20744-4019
Mailing Address - Country:US
Mailing Address - Phone:202-743-5660
Mailing Address - Fax:
Practice Address - Street 1:10903 INDIAN HEAD HWY STE 404
Practice Address - Street 2:
Practice Address - City:FORT WASHINGTON
Practice Address - State:MD
Practice Address - Zip Code:20744-4019
Practice Address - Country:US
Practice Address - Phone:202-743-5660
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-07-28
Last Update Date:2022-04-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0850XAmbulatory Health Care FacilitiesClinic/CenterAdult Mental Health
No261QR0400XAmbulatory Health Care FacilitiesClinic/CenterRehabilitation