Provider Demographics
NPI:1831151463
Name:HOLISTIC MENTAL HEALTH INC
Entity type:Organization
Organization Name:HOLISTIC MENTAL HEALTH INC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR PRESIDENT HOLISTIC MENTAL
Authorized Official - Prefix:
Authorized Official - First Name:CLARA
Authorized Official - Middle Name:ELIZABETH
Authorized Official - Last Name:EWING
Authorized Official - Suffix:
Authorized Official - Credentials:LMFT LPC CSAC
Authorized Official - Phone:757-826-2514
Mailing Address - Street 1:PO BOX 8084
Mailing Address - Street 2:
Mailing Address - City:HAMPTON
Mailing Address - State:VA
Mailing Address - Zip Code:23666
Mailing Address - Country:US
Mailing Address - Phone:757-826-2514
Mailing Address - Fax:757-826-5560
Practice Address - Street 1:2211 TODDS LANE
Practice Address - Street 2:
Practice Address - City:HAMPTON
Practice Address - State:VA
Practice Address - Zip Code:23666
Practice Address - Country:US
Practice Address - Phone:757-826-2514
Practice Address - Fax:757-826-5560
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-04-06
Last Update Date:2008-04-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0801XAmbulatory Health Care FacilitiesClinic/CenterMental Health (Including Community Mental Health Center)
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA5400261Medicaid