Provider Demographics
NPI:1184924359
Name:HOLISTIC SERVICES
Entity type:Organization
Organization Name:HOLISTIC SERVICES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/CEO
Authorized Official - Prefix:
Authorized Official - First Name:KIA
Authorized Official - Middle Name:ROBINSON
Authorized Official - Last Name:EDWARDS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:910-739-2477
Mailing Address - Street 1:4127 FAYETTEVILLE
Mailing Address - Street 2:
Mailing Address - City:LUMBERTON
Mailing Address - State:NC
Mailing Address - Zip Code:28358
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:4127 FAYETTEVILLE RD.
Practice Address - Street 2:SUITE B
Practice Address - City:LUMBERTON
Practice Address - State:NC
Practice Address - Zip Code:28358-2113
Practice Address - Country:US
Practice Address - Phone:910-739-2477
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-10-22
Last Update Date:2010-10-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health