Healthcare Provider Details

I. General information

NPI: 1174094593
Provider Name (Legal Business Name): WHOLE FAMILY HEALING GROUP, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/11/2018
Last Update Date: 01/27/2021
Certification Date: 01/27/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

104 CHURCH LN STE 120
PIKESVILLE MD
21208-3786
US

IV. Provider business mailing address

1325 BEDFORD AVE UNIT 32405
PIKESVILLE MD
21282-7550
US

V. Phone/Fax

Practice location:
  • Phone: 410-413-6043
  • Fax: 410-559-6510
Mailing address:
  • Phone: 443-979-3295
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code261QM0801X
TaxonomyMental Health Clinic/Center (Including Community Mental Health Center)
License Number
License Number StateNULL
# 2
Primary TaxonomyN
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number StateNULL
# 3
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number
License Number StateNULL
# 4
Primary TaxonomyN
Taxonomy Code251S00000X
TaxonomyCommunity/Behavioral Health Agency
License Number
License Number StateNULL

VIII. Authorized Official

Name: MIESHA RICE
Title or Position: CLINICAL SOCIAL WORKER/OWNER
Credential: LCSW-C
Phone: 443-979-3295