Healthcare Provider Details

I. General information

NPI: 1609485580
Provider Name (Legal Business Name): HEALING-CIRCLE,LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/28/2020
Last Update Date: 07/28/2020
Certification Date: 07/28/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8730 GEORGIA AVE STE 200D
SILVER SPRING MD
20910-3651
US

IV. Provider business mailing address

8730 GEORGIA AVE STE 200D
SILVER SPRING MD
20910-3651
US

V. Phone/Fax

Practice location:
  • Phone: 773-569-1827
  • Fax:
Mailing address:
  • Phone: 773-569-1827
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number State

VIII. Authorized Official

Name: LESLIE HOLLEY
Title or Position: OWNER
Credential: MA, LCPC, NCC
Phone: 312-775-2316