Provider Demographics
NPI:1881317378
Name:HOLISTIC WELLNESS BY KEISHA
Entity type:Organization
Organization Name:HOLISTIC WELLNESS BY KEISHA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:KEISHA
Authorized Official - Middle Name:CARTER
Authorized Official - Last Name:BROWN
Authorized Official - Suffix:
Authorized Official - Credentials:LCSW
Authorized Official - Phone:407-289-1828
Mailing Address - Street 1:525 TRIBBLE GAP RD UNIT 1031
Mailing Address - Street 2:
Mailing Address - City:CUMMING
Mailing Address - State:GA
Mailing Address - Zip Code:30028-2910
Mailing Address - Country:US
Mailing Address - Phone:470-289-1828
Mailing Address - Fax:
Practice Address - Street 1:6495 YELLOW BIRCH ST
Practice Address - Street 2:
Practice Address - City:CUMMING
Practice Address - State:GA
Practice Address - Zip Code:30040-1905
Practice Address - Country:US
Practice Address - Phone:470-289-1828
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-09-21
Last Update Date:2022-09-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes104100000XBehavioral Health & Social Service ProvidersSocial WorkerGroup - Multi-Specialty