Provider Demographics
NPI:1740876713
Name:HOLISTIC EXPRESSION AND CONSULTATION SERVICES
Entity type:Organization
Organization Name:HOLISTIC EXPRESSION AND CONSULTATION SERVICES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:CHRISHONA
Authorized Official - Middle Name:
Authorized Official - Last Name:HENRY
Authorized Official - Suffix:
Authorized Official - Credentials:LPC,RN
Authorized Official - Phone:860-794-7103
Mailing Address - Street 1:8300 SIR LIONEL PL
Mailing Address - Street 2:
Mailing Address - City:NORTH CHESTERFIELD
Mailing Address - State:VA
Mailing Address - Zip Code:23237-4727
Mailing Address - Country:US
Mailing Address - Phone:860-794-7103
Mailing Address - Fax:
Practice Address - Street 1:1 W WILLIAMSBURG RD
Practice Address - Street 2:
Practice Address - City:SANDSTON
Practice Address - State:VA
Practice Address - Zip Code:23150-2009
Practice Address - Country:US
Practice Address - Phone:804-322-9796
Practice Address - Fax:804-276-4504
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-12-14
Last Update Date:2020-12-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Multi-Specialty
No163W00000XNursing Service ProvidersRegistered NurseGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA601381941Medicaid