HOLISTIC HUMAN SERVICES, INC.

Provider Demographics

• NPI: 1740517226
• Name: HOLISTIC HUMAN SERVICES, INC.
• Entity type: Organization
• Organization Name: HOLISTIC HUMAN SERVICES, INC.
• Authorized Official - Title/Position: PROGRAM EXECUTIVE DIRECTOR
• Authorized Official - First Name: KEITH
• Authorized Official - Middle Name: EDWARD
• Authorized Official - Last Name: GREEN
• Authorized Official - Credentials: MED
• Authorized Official - Phone: 888-582-0224
• Mailing Address - Street 1: PO BOX 671
• Mailing Address - City: CARRBORO
• Mailing Address - State: NC
• Mailing Address - Zip Code: 27510-0671
• Mailing Address - Country: US
• Mailing Address - Phone: 888-582-0224
• Mailing Address - Fax: 888-580-6555
• Practice Address - Street 1: 4310 REGENCY DR STE 100, 106
• Practice Address - City: HIGH POINT
• Practice Address - State: NC
• Practice Address - Zip Code: 27265-9487
• Practice Address - Country: US
• Practice Address - Phone: 888-582-0224
• Practice Address - Fax: 888-982-6555
• EIN: <UNAVAIL>
• Is Organization Subpart?: No
• Enumeration Date: 2009-11-04
• Last Update Date: 2011-05-24

Provider Licenses

State	License ID	Taxonomies
		101YM0800X, 251S00000X
NC	5084	101YP2500X
NC	1581	103T00000X
NC	1449	103TC0700X

Provider Taxonomies

Primary?	Code	Type	Classification	Specialization	Group
Yes	101YM0800X	Behavioral Health & Social Service Providers	Counselor	Mental Health	Group - Multi-Specialty
No	101YP2500X	Behavioral Health & Social Service Providers	Counselor	Professional	Group - Multi-Specialty
No	103T00000X	Behavioral Health & Social Service Providers	Psychologist		Group - Multi-Specialty
No	103TC0700X	Behavioral Health & Social Service Providers	Psychologist	Clinical	Group - Multi-Specialty
No	251S00000X	Agencies	Community/Behavioral Health		Group - Multi-Specialty

Provider Identifiers

State	Identifier ID	ID Type	Issuer
NC	8302895G	Medicaid
NC	8302895H	Medicaid
NC	8302895S	Medicaid
NC	8302308	Medicaid
NC	3418975	Medicaid
NC	8302895Q	Medicaid
NC	8302895B	Medicaid
NC	8302895	Medicaid