Healthcare Provider Details

I. General information

NPI: 1760178131
Provider Name (Legal Business Name): HOLISTIC HEALTH- COUNSELING & COACHING LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/17/2023
Last Update Date: 04/17/2023
Certification Date: 04/17/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7 CEDAR ST
CAMBRIDGE MD
21613-2381
US

IV. Provider business mailing address

2453 MARYLAND AVE
BALTIMORE MD
21218-5018
US

V. Phone/Fax

Practice location:
  • Phone: 443-853-8686
  • Fax:
Mailing address:
  • Phone: 410-804-8000
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2084A0401X
TaxonomyAddiction Medicine (Psychiatry & Neurology) Physician
License Number
License Number State

VIII. Authorized Official

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