Healthcare Provider Details

I. General information

NPI: 1982845392
Provider Name (Legal Business Name): HOLISTIC HUMAN SERVICES, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/13/2009
Last Update Date: 05/23/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

150 PROVIDENCE RD SUITE 100-G
CHAPEL HILL NC
27514-2208
US

IV. Provider business mailing address

PO BOX 671
CARRBORO NC
27510-0671
US

V. Phone/Fax

Practice location:
  • Phone: 888-582-0224
  • Fax: 888-580-6555
Mailing address:
  • Phone: 888-582-0224
  • Fax: 888-580-6555

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number5084
License Number StateNC
# 3
Primary TaxonomyN
Taxonomy Code103T00000X
TaxonomyPsychologist
License Number1581
License Number StateNC
# 4
Primary TaxonomyN
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License Number1449
License Number StateNC
# 5
Primary TaxonomyN
Taxonomy Code251C00000X
TaxonomyDevelopmentally Disabled Services Day Training Agency
License NumberMHL-032-490
License Number StateNC
# 6
Primary TaxonomyN
Taxonomy Code251S00000X
TaxonomyCommunity/Behavioral Health Agency
License Number
License Number State

VIII. Authorized Official

Name: KEITH EDWARD GREEN
Title or Position: PROGRAM DIRECTOR
Credential: M.ED.
Phone: 888-582-0224