Healthcare Provider Details

I. General information

NPI: 1487483715
Provider Name (Legal Business Name): HOLISTIC MENTAL WELLNESS CENTER LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/26/2024
Last Update Date: 07/26/2024
Certification Date: 07/26/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

519 E INDIAN SPRING DR
SILVER SPRING MD
20901-4726
US

IV. Provider business mailing address

519 E INDIAN SPRING DR
SILVER SPRING MD
20901-4726
US

V. Phone/Fax

Practice location:
  • Phone: 240-476-6676
  • Fax:
Mailing address:
  • Phone: 240-476-6676
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number
License Number State

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

VIII. Authorized Official

Name: MS. MIRAF KEBEDE
Title or Position: MENTAL HEALTH THERAPIST
Credential: SOCIAL WORKER, LICSW
Phone: 240-476-6676