Provider Demographics
NPI:1740587153
Name:HOLISTIC HEALTH CENTER FOR PERSONAL GROWTH AND HEALING
Entity Type:Organization
Organization Name:HOLISTIC HEALTH CENTER FOR PERSONAL GROWTH AND HEALING
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PSYCHOTHERAPIST
Authorized Official - Prefix:MS
Authorized Official - First Name:KRISTIE
Authorized Official - Middle Name:
Authorized Official - Last Name:DOHENY
Authorized Official - Suffix:
Authorized Official - Credentials:LMHC, LMSW
Authorized Official - Phone:347-255-2087
Mailing Address - Street 1:8530 262ND ST
Mailing Address - Street 2:
Mailing Address - City:FLORAL PARK
Mailing Address - State:NY
Mailing Address - Zip Code:11001-1128
Mailing Address - Country:US
Mailing Address - Phone:357-255-2087
Mailing Address - Fax:
Practice Address - Street 1:7613 113TH ST
Practice Address - Street 2:
Practice Address - City:FOREST HILLS
Practice Address - State:NY
Practice Address - Zip Code:11375-6587
Practice Address - Country:US
Practice Address - Phone:347-255-2087
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-02-21
Last Update Date:2011-02-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY002281101YM0800X
NY0810871041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Multi-Specialty
No1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY1225361421OtherNPI