Provider Demographics
NPI:1013884436
Name:HOLISTIC THERAPY AND LIFE COACHING
Entity type:Organization
Organization Name:HOLISTIC THERAPY AND LIFE COACHING
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MRS
Authorized Official - First Name:JACQUELINE
Authorized Official - Middle Name:
Authorized Official - Last Name:MALCOLM
Authorized Official - Suffix:
Authorized Official - Credentials:LCSW
Authorized Official - Phone:615-424-3912
Mailing Address - Street 1:25419 HUNTLEY LN
Mailing Address - Street 2:
Mailing Address - City:CARTHAGE
Mailing Address - State:NY
Mailing Address - Zip Code:13619-7502
Mailing Address - Country:US
Mailing Address - Phone:615-424-3912
Mailing Address - Fax:315-800-6487
Practice Address - Street 1:200 WASHINGTON ST STE 205
Practice Address - Street 2:
Practice Address - City:WATERTOWN
Practice Address - State:NY
Practice Address - Zip Code:13601-3335
Practice Address - Country:US
Practice Address - Phone:315-775-8838
Practice Address - Fax:315-800-6487
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2025-10-21
Last Update Date:2025-10-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Multi-Specialty