Provider Demographics
NPI:1669651113
Name:HOLISTIC HEALTH ASSOCIATES
Entity type:Organization
Organization Name:HOLISTIC HEALTH ASSOCIATES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CO-OWNER, LICENSED ACUPUNCTURIST
Authorized Official - Prefix:MR
Authorized Official - First Name:RYAN
Authorized Official - Middle Name:CRAIG
Authorized Official - Last Name:DIENER
Authorized Official - Suffix:
Authorized Official - Credentials:LAC, DIPLCH
Authorized Official - Phone:301-620-1414
Mailing Address - Street 1:315 W PATRICK ST
Mailing Address - Street 2:
Mailing Address - City:FREDERICK
Mailing Address - State:MD
Mailing Address - Zip Code:21701-4855
Mailing Address - Country:US
Mailing Address - Phone:301-620-1414
Mailing Address - Fax:703-814-8697
Practice Address - Street 1:315 W PATRICK ST
Practice Address - Street 2:
Practice Address - City:FREDERICK
Practice Address - State:MD
Practice Address - Zip Code:21701-4855
Practice Address - Country:US
Practice Address - Phone:301-620-1414
Practice Address - Fax:703-814-8697
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-11-01
Last Update Date:2007-11-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDUO1332171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes171100000XOther Service ProvidersAcupuncturistGroup - Multi-Specialty