Provider Demographics
NPI:1639850316
Name:HOLISTIC HEALTH AND WELLNESS LLC
Entity Type:Organization
Organization Name:HOLISTIC HEALTH AND WELLNESS LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:MICHELLE
Authorized Official - Middle Name:
Authorized Official - Last Name:BLACKSTON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:410-517-7060
Mailing Address - Street 1:1105 N POINT BLVD STE 321
Mailing Address - Street 2:
Mailing Address - City:BALTIMORE
Mailing Address - State:MD
Mailing Address - Zip Code:21224-3472
Mailing Address - Country:US
Mailing Address - Phone:410-517-7060
Mailing Address - Fax:443-407-2942
Practice Address - Street 1:1105 N POINT BLVD STE 321
Practice Address - Street 2:
Practice Address - City:BALTIMORE
Practice Address - State:MD
Practice Address - Zip Code:21224-3472
Practice Address - Country:US
Practice Address - Phone:410-517-7060
Practice Address - Fax:443-407-2942
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-07-26
Last Update Date:2023-07-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)Group - Multi-Specialty