Provider Demographics
NPI:1932639663
Name:HOLISTIC TREATMENT CENTER
Entity Type:Organization
Organization Name:HOLISTIC TREATMENT CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:RENEE
Authorized Official - Middle Name:
Authorized Official - Last Name:BUTLER
Authorized Official - Suffix:
Authorized Official - Credentials:LCSW-CQ
Authorized Official - Phone:571-490-1421
Mailing Address - Street 1:12301 LOCH CARRON CIR
Mailing Address - Street 2:
Mailing Address - City:FORT WASHINGTON
Mailing Address - State:MD
Mailing Address - Zip Code:20744-7017
Mailing Address - Country:US
Mailing Address - Phone:571-490-1421
Mailing Address - Fax:
Practice Address - Street 1:3050 CRAIN HWY STE 200
Practice Address - Street 2:
Practice Address - City:WALDORF
Practice Address - State:MD
Practice Address - Zip Code:20601-2822
Practice Address - Country:US
Practice Address - Phone:571-490-1421
Practice Address - Fax:571-490-1421
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-06-15
Last Update Date:2017-06-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD20563261Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261Q00000XAmbulatory Health Care FacilitiesClinic/Center
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD103795100Medicaid