Healthcare Provider Details

I. General information

NPI: 1578429635
Provider Name (Legal Business Name): HOLY CLINIC, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/01/2026
Last Update Date: 01/05/2026
Certification Date: 01/05/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6018 HARFORD RD
BALTIMORE MD
21214-1327
US

IV. Provider business mailing address

6018 HARFORD RD
BALTIMORE MD
21214-1327
US

V. Phone/Fax

Practice location:
  • Phone: 443-559-7259
  • Fax: 410-401-8110
Mailing address:
  • Phone: 443-559-7259
  • Fax: 410-401-8110

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number
License Number State

VIII. Authorized Official

Name: DORIS C. DICKSON
Title or Position: CRNP/CEO
Credential: FNP
Phone: 443-559-7259