Provider Demographics
NPI:1710967997
Name:CENTER FOR HOLISTIC HEALING PC
Entity Type:Organization
Organization Name:CENTER FOR HOLISTIC HEALING PC
Other - Org Name:THE CENTER FOR EMOTIONAL HEALING PC
Other - Org Type:Former Legal Business Name
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:ROBERT
Authorized Official - Middle Name:C
Authorized Official - Last Name:GOODMAN
Authorized Official - Suffix:
Authorized Official - Credentials:LCSW
Authorized Official - Phone:336-841-4307
Mailing Address - Street 1:3929 TINSLEY DR STE 104
Mailing Address - Street 2:
Mailing Address - City:HIGH POINT
Mailing Address - State:NC
Mailing Address - Zip Code:27265-1531
Mailing Address - Country:US
Mailing Address - Phone:336-841-4307
Mailing Address - Fax:336-841-7267
Practice Address - Street 1:3929 TINSLEY DR STE 104
Practice Address - Street 2:
Practice Address - City:HIGH POINT
Practice Address - State:NC
Practice Address - Zip Code:27265-1531
Practice Address - Country:US
Practice Address - Phone:336-841-4307
Practice Address - Fax:336-841-7267
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-01-23
Last Update Date:2019-01-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC3894101YP2500X
NCC0034391041C0700X
NC882106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Single Specialty
No101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessionalGroup - Single Specialty
No106H00000XBehavioral Health & Social Service ProvidersMarriage & Family TherapistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC6005696Medicaid
NC6005696Medicaid