Provider Demographics
NPI:1811689599
Name:HOLISTIC TELEPSYCH & MED MGT. LLC
Entity type:Organization
Organization Name:HOLISTIC TELEPSYCH & MED MGT. LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PSYCHIATRIC NURSE PRACTITIONER
Authorized Official - Prefix:MR
Authorized Official - First Name:LEWIS
Authorized Official - Middle Name:CHRISTOPHER
Authorized Official - Last Name:WILSON
Authorized Official - Suffix:
Authorized Official - Credentials:PSYCH NP
Authorized Official - Phone:301-741-2232
Mailing Address - Street 1:8306 LARCHWOOD ST
Mailing Address - Street 2:
Mailing Address - City:NEW CARROLLTON
Mailing Address - State:MD
Mailing Address - Zip Code:20784-3409
Mailing Address - Country:US
Mailing Address - Phone:301-741-2232
Mailing Address - Fax:301-459-4252
Practice Address - Street 1:8306 LARCHWOOD ST
Practice Address - Street 2:
Practice Address - City:NEW CARROLLTON
Practice Address - State:MD
Practice Address - Zip Code:20784-3409
Practice Address - Country:US
Practice Address - Phone:301-741-2232
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-05-22
Last Update Date:2023-05-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0850XAmbulatory Health Care FacilitiesClinic/CenterAdult Mental Health