Provider Demographics
NPI:1588552640
Name:HOLISTIC REPRODUCTIVE WELLNESS GROUP
Entity type:Organization
Organization Name:HOLISTIC REPRODUCTIVE WELLNESS GROUP
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/PROVIDER
Authorized Official - Prefix:
Authorized Official - First Name:AASTASSHIA
Authorized Official - Middle Name:LYNN
Authorized Official - Last Name:LACY
Authorized Official - Suffix:
Authorized Official - Credentials:NP
Authorized Official - Phone:410-870-9567
Mailing Address - Street 1:3030 GREENMOUNT AVE STE 300
Mailing Address - Street 2:
Mailing Address - City:BALTIMORE
Mailing Address - State:MD
Mailing Address - Zip Code:21218-6907
Mailing Address - Country:US
Mailing Address - Phone:410-870-9567
Mailing Address - Fax:949-864-3194
Practice Address - Street 1:2806 BREWERS CROSSING WAY
Practice Address - Street 2:
Practice Address - City:HANOVER
Practice Address - State:MD
Practice Address - Zip Code:21076-2902
Practice Address - Country:US
Practice Address - Phone:480-242-1736
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2025-06-26
Last Update Date:2025-06-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207VM0101XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyMaternal & Fetal MedicineGroup - Single Specialty