Provider Demographics
NPI:1659900488
Name:HOLISTIC PSYCHOHEALTH SERVICES LLC
Entity Type:Organization
Organization Name:HOLISTIC PSYCHOHEALTH SERVICES LLC
Other - Org Name:HPS COUNSELING
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:GERMAINE
Authorized Official - Middle Name:
Authorized Official - Last Name:AJAVON
Authorized Official - Suffix:
Authorized Official - Credentials:LCPC
Authorized Official - Phone:410-736-8010
Mailing Address - Street 1:632 FREDERICK RD # 200
Mailing Address - Street 2:
Mailing Address - City:CATONSVILLE
Mailing Address - State:MD
Mailing Address - Zip Code:21228-4696
Mailing Address - Country:US
Mailing Address - Phone:443-892-0553
Mailing Address - Fax:
Practice Address - Street 1:632 FREDERICK RD # 200
Practice Address - Street 2:
Practice Address - City:CATONSVILLE
Practice Address - State:MD
Practice Address - Zip Code:21228-4696
Practice Address - Country:US
Practice Address - Phone:443-892-0553
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-04-03
Last Update Date:2023-06-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessionalGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD223048800Medicaid
601522332OtherMAGELLAN
MDFF08-0000OtherCAREFIRST