Healthcare Provider Details

I. General information

NPI: 1467125104
Provider Name (Legal Business Name): ETW THERAPEUTIC & HOLISTIC SERVICES LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/28/2021
Last Update Date: 11/07/2024
Certification Date: 11/07/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7305 BALTIMORE AVE # A101
COLLEGE PARK MD
20740-3234
US

IV. Provider business mailing address

7206 SHOCKLEY CT
FORT WASHINGTON MD
20744-1711
US

V. Phone/Fax

Practice location:
  • Phone: 202-743-5660
  • Fax:
Mailing address:
  • Phone: 202-743-5660
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QM0850X
TaxonomyAdult Mental Health Clinic/Center
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code261QR0400X
TaxonomyRehabilitation Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: DR. ERIC WHITAKER
Title or Position: PRESIDENT/CEO
Credential: PHD, LCSW-C, LICSW
Phone: 202-743-5660