Provider Demographics
NPI:1871044990
Name:HOLISTIC PSYCHOLOGICAL ASSOCIATES, LLC
Entity Type:Organization
Organization Name:HOLISTIC PSYCHOLOGICAL ASSOCIATES, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:BILLING MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:AMEERA
Authorized Official - Middle Name:
Authorized Official - Last Name:ALI
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:678-793-1383
Mailing Address - Street 1:PO BOX 291558
Mailing Address - Street 2:
Mailing Address - City:COLUMBIA
Mailing Address - State:SC
Mailing Address - Zip Code:29229-0026
Mailing Address - Country:US
Mailing Address - Phone:803-736-8001
Mailing Address - Fax:
Practice Address - Street 1:9570 TWO NOTCH RD
Practice Address - Street 2:STE 9
Practice Address - City:COLUMBIA
Practice Address - State:SC
Practice Address - Zip Code:29223-4308
Practice Address - Country:US
Practice Address - Phone:678-793-1383
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-10-24
Last Update Date:2016-10-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC5508101YP2500X
SC6121101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessionalGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
SC30180161Medicaid