Provider Demographics
NPI:1578734778
Name:WHOLISTIC COUNSELING AND WELLNESS ALTERNATIVES LLC
Entity Type:Organization
Organization Name:WHOLISTIC COUNSELING AND WELLNESS ALTERNATIVES LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:CHRISTIAN
Authorized Official - Middle Name:FAITH
Authorized Official - Last Name:NUNES
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:800-579-1407
Mailing Address - Street 1:10640 N 28TH DR STE C101
Mailing Address - Street 2:
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85029-2993
Mailing Address - Country:US
Mailing Address - Phone:800-579-1407
Mailing Address - Fax:877-217-5895
Practice Address - Street 1:10640 N 28TH DR STE C101
Practice Address - Street 2:
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85029-2993
Practice Address - Country:US
Practice Address - Phone:800-579-1407
Practice Address - Fax:877-217-5895
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-03-14
Last Update Date:2018-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselorGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ984246Medicaid