Provider Demographics
NPI:1952849762
Name:HOLISTIC COUNSELING AND SOCIAL SERVICES
Entity Type:Organization
Organization Name:HOLISTIC COUNSELING AND SOCIAL SERVICES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:T
Authorized Official - Middle Name:
Authorized Official - Last Name:RILEY
Authorized Official - Suffix:
Authorized Official - Credentials:LMHC
Authorized Official - Phone:904-600-2675
Mailing Address - Street 1:1225 W BEAVER ST STE 208
Mailing Address - Street 2:
Mailing Address - City:JACKSONVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32204-1416
Mailing Address - Country:US
Mailing Address - Phone:904-600-2675
Mailing Address - Fax:
Practice Address - Street 1:1225 W BEAVER ST STE 208
Practice Address - Street 2:
Practice Address - City:JACKSONVILLE
Practice Address - State:FL
Practice Address - Zip Code:32204-1416
Practice Address - Country:US
Practice Address - Phone:904-600-2675
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-02-01
Last Update Date:2017-02-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health
No251B00000XAgenciesCase Management
No251K00000XAgenciesPublic Health or Welfare