Provider Demographics
NPI:1396279790
Name:HOLISTIC COUNSELING GROUP, LLC
Entity type:Organization
Organization Name:HOLISTIC COUNSELING GROUP, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MEMBER
Authorized Official - Prefix:MRS
Authorized Official - First Name:NICOLE
Authorized Official - Middle Name:
Authorized Official - Last Name:SILVERIO
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:305-984-4483
Mailing Address - Street 1:6900 TAVISTOCK LAKES BLVD
Mailing Address - Street 2:SUITE 400
Mailing Address - City:ORLANDO
Mailing Address - State:FL
Mailing Address - Zip Code:32827-7589
Mailing Address - Country:US
Mailing Address - Phone:321-667-2197
Mailing Address - Fax:407-562-3837
Practice Address - Street 1:6900 TAVISTOCK LAKES BLVD
Practice Address - Street 2:SUITE 400
Practice Address - City:ORLANDO
Practice Address - State:FL
Practice Address - Zip Code:32827-7589
Practice Address - Country:US
Practice Address - Phone:321-667-2197
Practice Address - Fax:407-562-3837
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-04-12
Last Update Date:2017-04-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
106H00000X
FLMH12417101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Multi-Specialty
No106H00000XBehavioral Health & Social Service ProvidersMarriage & Family TherapistGroup - Multi-Specialty