Provider Demographics
NPI:1356515167
Name:SKYEIA HOLISTIC SERVICES, LLC
Entity type:Organization
Organization Name:SKYEIA HOLISTIC SERVICES, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:MELISA
Authorized Official - Middle Name:M
Authorized Official - Last Name:CARRICO
Authorized Official - Suffix:
Authorized Official - Credentials:LCPC
Authorized Official - Phone:240-321-2487
Mailing Address - Street 1:1138 EAGLE ROCK RD
Mailing Address - Street 2:
Mailing Address - City:OAKLAND
Mailing Address - State:MD
Mailing Address - Zip Code:21550-6825
Mailing Address - Country:US
Mailing Address - Phone:240-321-2487
Mailing Address - Fax:301-334-5922
Practice Address - Street 1:315 DAWSON AVE STE C
Practice Address - Street 2:
Practice Address - City:OAKLAND
Practice Address - State:MD
Practice Address - Zip Code:21550-5113
Practice Address - Country:US
Practice Address - Phone:240-321-2487
Practice Address - Fax:301-334-5922
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-04-14
Last Update Date:2010-12-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDLC1331101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD012466400Medicaid