Provider Demographics
NPI:1952097701
Name:HOLISTIC CHANGE LLC
Entity Type:Organization
Organization Name:HOLISTIC CHANGE LLC
Other - Org Name:HOLISTIC CHANGE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:JAMES
Authorized Official - Middle Name:BERNARD
Authorized Official - Last Name:SCOTT
Authorized Official - Suffix:III
Authorized Official - Credentials:
Authorized Official - Phone:443-468-6169
Mailing Address - Street 1:11 GWYNNS MILL CT STE K
Mailing Address - Street 2:
Mailing Address - City:OWINGS MILLS
Mailing Address - State:MD
Mailing Address - Zip Code:21117-3500
Mailing Address - Country:US
Mailing Address - Phone:443-468-6169
Mailing Address - Fax:
Practice Address - Street 1:2710 W COLD SPRING LN
Practice Address - Street 2:
Practice Address - City:BALTIMORE
Practice Address - State:MD
Practice Address - Zip Code:21215-6702
Practice Address - Country:US
Practice Address - Phone:800-395-9636
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-04-14
Last Update Date:2023-05-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QR0405XAmbulatory Health Care FacilitiesClinic/CenterRehabilitation, Substance Use Disorder
No251S00000XAgenciesCommunity/Behavioral Health
No324500000XResidential Treatment FacilitiesSubstance Abuse Rehabilitation Facility