Provider Demographics
NPI:1811677438
Name:HOLISTIC BEHAVIORAL HEALTHCARE LLC
Entity type:Organization
Organization Name:HOLISTIC BEHAVIORAL HEALTHCARE LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGING ONWER
Authorized Official - Prefix:
Authorized Official - First Name:CARINE
Authorized Official - Middle Name:
Authorized Official - Last Name:DJUIDJE
Authorized Official - Suffix:
Authorized Official - Credentials:NP
Authorized Official - Phone:513-238-0267
Mailing Address - Street 1:1721 BROAD ST
Mailing Address - Street 2:
Mailing Address - City:SELMA
Mailing Address - State:AL
Mailing Address - Zip Code:36701-4116
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:1721 BROAD ST
Practice Address - Street 2:
Practice Address - City:SELMA
Practice Address - State:AL
Practice Address - Zip Code:36701-4116
Practice Address - Country:US
Practice Address - Phone:513-238-0267
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-07-19
Last Update Date:2023-07-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental HealthGroup - Multi-Specialty