Healthcare Provider Details

I. General information

NPI: 1699218602
Provider Name (Legal Business Name): HOLISTIC SERVICES INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/22/2016
Last Update Date: 11/22/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

969 W MAIN ST SUITE 1 D
WATERBURY CT
06708-2653
US

IV. Provider business mailing address

969 W MAIN ST SUITE 1 D
WATERBURY CT
06708-2653
US

V. Phone/Fax

Practice location:
  • Phone: 203-596-0857
  • Fax: 203-900-0672
Mailing address:
  • Phone: 203-596-0857
  • Fax: 203-900-0672

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number
License Number State
# 4
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License Number
License Number State

VIII. Authorized Official

Name: LORI PELOSI
Title or Position: CO OWNER
Credential: APRN
Phone: 203-596-0857