Provider Demographics
NPI:1578108767
Name:WHOLISTIC WELLNESS COUNSELING AND CONSULTING LLC
Entity Type:Organization
Organization Name:WHOLISTIC WELLNESS COUNSELING AND CONSULTING LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MRS
Authorized Official - First Name:JESSICA
Authorized Official - Middle Name:
Authorized Official - Last Name:POLUBINSKY
Authorized Official - Suffix:
Authorized Official - Credentials:LMHC
Authorized Official - Phone:260-600-1069
Mailing Address - Street 1:1129 RIVERMET AVE
Mailing Address - Street 2:
Mailing Address - City:FORT WAYNE
Mailing Address - State:IN
Mailing Address - Zip Code:46805-4232
Mailing Address - Country:US
Mailing Address - Phone:260-602-1069
Mailing Address - Fax:
Practice Address - Street 1:1129 RIVERMET AVE
Practice Address - Street 2:
Practice Address - City:FORT WAYNE
Practice Address - State:IN
Practice Address - Zip Code:46805-4232
Practice Address - Country:US
Practice Address - Phone:260-602-1069
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-11-11
Last Update Date:2019-11-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Multi-Specialty