Provider Demographics
NPI:1790192607
Name:HEALING GODDESS INTERPRISES LLC
Entity Type:Organization
Organization Name:HEALING GODDESS INTERPRISES LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:VICKY
Authorized Official - Middle Name:
Authorized Official - Last Name:PRIMER
Authorized Official - Suffix:
Authorized Official - Credentials:PHD
Authorized Official - Phone:301-751-0695
Mailing Address - Street 1:15 CRAGMERE RD
Mailing Address - Street 2:
Mailing Address - City:WILMINGTON
Mailing Address - State:DE
Mailing Address - Zip Code:19809-2308
Mailing Address - Country:US
Mailing Address - Phone:301-751-0695
Mailing Address - Fax:
Practice Address - Street 1:15 CRAGMERE RD
Practice Address - Street 2:
Practice Address - City:WILMINGTON
Practice Address - State:DE
Practice Address - Zip Code:19809-2308
Practice Address - Country:US
Practice Address - Phone:301-751-0695
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-07-14
Last Update Date:2014-07-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DEFT-0000008106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family TherapistGroup - Multi-Specialty