Provider Demographics
NPI:1679021570
Name:HOLISTIC THERAPY LLC
Entity Type:Organization
Organization Name:HOLISTIC THERAPY LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/PSYCHOTHERAPIST
Authorized Official - Prefix:
Authorized Official - First Name:NIKITA
Authorized Official - Middle Name:
Authorized Official - Last Name:PION-KLOCKNER
Authorized Official - Suffix:
Authorized Official - Credentials:LCSW
Authorized Official - Phone:202-495-0876
Mailing Address - Street 1:7034 CARROLL AVE STE 1
Mailing Address - Street 2:
Mailing Address - City:TAKOMA PARK
Mailing Address - State:MD
Mailing Address - Zip Code:20912-4434
Mailing Address - Country:US
Mailing Address - Phone:202-495-0876
Mailing Address - Fax:
Practice Address - Street 1:7034 CARROLL AVE STE 1
Practice Address - Street 2:
Practice Address - City:TAKOMA PARK
Practice Address - State:MD
Practice Address - Zip Code:20912-4434
Practice Address - Country:US
Practice Address - Phone:202-495-0876
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-09-20
Last Update Date:2016-09-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD165701041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Single Specialty