Healthcare Provider Details

I. General information

NPI: 1710252879
Provider Name (Legal Business Name): HOLISTIC SERVICES INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/21/2012
Last Update Date: 03/21/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2003 GODWIN AVE STE C
LUMBERTON NC
28358-3150
US

IV. Provider business mailing address

2003 GODWIN AVE STE C
LUMBERTON NC
28358-3150
US

V. Phone/Fax

Practice location:
  • Phone: 910-739-2477
  • Fax: 910-739-2478
Mailing address:
  • Phone: 910-739-2477
  • Fax: 910-739-2478

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251B00000X
TaxonomyCase Management Agency
License Number
License Number StateNC
# 2
Primary TaxonomyN
Taxonomy Code251S00000X
TaxonomyCommunity/Behavioral Health Agency
License Number
License Number State

VIII. Authorized Official

Name: MRS. CAROLYN FLOYD ROBINSON
Title or Position: CLINICAL DIRECTOR
Credential: LCAS
Phone: 910-739-2477