Provider Demographics
NPI:1134396161
Name:HOLISTIC URBAN GUIDANCE CENTER, INC
Entity type:Organization
Organization Name:HOLISTIC URBAN GUIDANCE CENTER, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MS
Authorized Official - First Name:DEANNA
Authorized Official - Middle Name:V
Authorized Official - Last Name:JOHNSON
Authorized Official - Suffix:
Authorized Official - Credentials:MS, APRN, BC
Authorized Official - Phone:973-325-7345
Mailing Address - Street 1:10 BROOK END DR
Mailing Address - Street 2:
Mailing Address - City:WEST ORANGE
Mailing Address - State:NJ
Mailing Address - Zip Code:07052-1303
Mailing Address - Country:US
Mailing Address - Phone:973-325-7345
Mailing Address - Fax:973-325-3715
Practice Address - Street 1:10 BROOK END DR
Practice Address - Street 2:
Practice Address - City:WEST ORANGE
Practice Address - State:NJ
Practice Address - Zip Code:07052-1303
Practice Address - Country:US
Practice Address - Phone:973-325-7345
Practice Address - Fax:973-325-3715
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-05-09
Last Update Date:2008-05-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ26NR04888600364SP0809X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes364SP0809XPhysician Assistants & Advanced Practice Nursing ProvidersClinical Nurse SpecialistPsychiatric/Mental Health, AdultGroup - Single Specialty