Provider Demographics
NPI:1982845392
Name:HOLISTIC HUMAN SERVICES, INC.
Entity Type:Organization
Organization Name:HOLISTIC HUMAN SERVICES, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PROGRAM DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:KEITH
Authorized Official - Middle Name:EDWARD
Authorized Official - Last Name:GREEN
Authorized Official - Suffix:
Authorized Official - Credentials:MED
Authorized Official - Phone:888-582-0224
Mailing Address - Street 1:PO BOX 671
Mailing Address - Street 2:
Mailing Address - City:CARRBORO
Mailing Address - State:NC
Mailing Address - Zip Code:27510-0671
Mailing Address - Country:US
Mailing Address - Phone:888-582-0224
Mailing Address - Fax:888-580-6555
Practice Address - Street 1:150 PROVIDENCE RD
Practice Address - Street 2:SUITE 100-G
Practice Address - City:CHAPEL HILL
Practice Address - State:NC
Practice Address - Zip Code:27514-2208
Practice Address - Country:US
Practice Address - Phone:888-582-0224
Practice Address - Fax:888-580-6555
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-03-13
Last Update Date:2011-05-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
101YM0800X, 251S00000X
NC5084101YP2500X
NC1581103T00000X
NC1449103TC0700X
NCMHL-032-490251C00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Multi-Specialty
No101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessionalGroup - Multi-Specialty
No103T00000XBehavioral Health & Social Service ProvidersPsychologistGroup - Multi-Specialty
No103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinicalGroup - Multi-Specialty
No251C00000XAgenciesDay Training, Developmentally Disabled Services
No251S00000XAgenciesCommunity/Behavioral HealthGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC6006774Medicaid
NC8302895Medicaid
GA809275207CMedicaid
NC8302895BMedicaid
NC8302895GMedicaid
NC8302895HMedicaid
GA809275207BMedicaid
GA809275207AMedicaid