Healthcare Provider Details

I. General information

NPI: 1659731875
Provider Name (Legal Business Name): HOLISTIC SOCIAL SERVICES, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/01/2016
Last Update Date: 03/01/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3233 COOLIDGE HWY
BERKLEY MI
48072-1633
US

IV. Provider business mailing address

2211 S TELEGRAPH RD UNIT 7443
BLOOMFIELD HILLS MI
48302-4817
US

V. Phone/Fax

Practice location:
  • Phone: 248-470-3003
  • Fax: 248-674-4822
Mailing address:
  • Phone: 248-470-3003
  • Fax: 248-674-4822

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101Y00000X
TaxonomyCounselor
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number
License Number State

VIII. Authorized Official

Name: MRS. INDIRA HALL
Title or Position: OWNER
Credential: L.M.S.W.
Phone: 248-470-3003