Provider Demographics
NPI:1710252879
Name:HOLISTIC SERVICES INC.
Entity Type:Organization
Organization Name:HOLISTIC SERVICES INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CLINICAL DIRECTOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:CAROLYN
Authorized Official - Middle Name:FLOYD
Authorized Official - Last Name:ROBINSON
Authorized Official - Suffix:
Authorized Official - Credentials:LCAS
Authorized Official - Phone:910-739-2477
Mailing Address - Street 1:2003 GODWIN AVE STE C
Mailing Address - Street 2:
Mailing Address - City:LUMBERTON
Mailing Address - State:NC
Mailing Address - Zip Code:28358-3150
Mailing Address - Country:US
Mailing Address - Phone:910-739-2477
Mailing Address - Fax:910-739-2478
Practice Address - Street 1:2003 GODWIN AVE STE C
Practice Address - Street 2:
Practice Address - City:LUMBERTON
Practice Address - State:NC
Practice Address - Zip Code:28358-3150
Practice Address - Country:US
Practice Address - Phone:910-739-2477
Practice Address - Fax:910-739-2478
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-03-21
Last Update Date:2012-03-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC251B00000X
251S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251B00000XAgenciesCase Management
No251S00000XAgenciesCommunity/Behavioral Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC8702449Medicaid
NC8303156Medicaid