Healthcare Provider Details

I. General information

NPI: 1689363574
Provider Name (Legal Business Name): HOLISTIC HEALTH- COUNSELING & COACHING LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/05/2023
Last Update Date: 05/05/2023
Certification Date: 04/25/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2453 MARYLAND AVE
BALTIMORE MD
21218-5018
US

IV. Provider business mailing address

2453 MARYLAND AVE
BALTIMORE MD
21218-5018
US

V. Phone/Fax

Practice location:
  • Phone: 410-804-8000
  • Fax:
Mailing address:
  • Phone: 410-804-8000
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2084P0804X
TaxonomyChild & Adolescent Psychiatry Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code251E00000X
TaxonomyHome Health Agency
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code251S00000X
TaxonomyCommunity/Behavioral Health Agency
License Number
License Number State
# 4
Primary TaxonomyN
Taxonomy Code261QC1500X
TaxonomyCommunity Health Clinic/Center
License Number
License Number State
# 5
Primary TaxonomyY
Taxonomy Code261QM0801X
TaxonomyMental Health Clinic/Center (Including Community Mental Health Center)
License Number
License Number State
# 6
Primary TaxonomyN
Taxonomy Code261QS1000X
TaxonomyStudent Health Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: MR. MELVIN J JEWS
Title or Position: OWNER THERAPIST
Credential: LCPC
Phone: 410-804-5800