Healthcare Provider Details

I. General information

NPI: 1740587153
Provider Name (Legal Business Name): HOLISTIC HEALTH CENTER FOR PERSONAL GROWTH AND HEALING
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/21/2011
Last Update Date: 02/21/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7613 113TH ST
FOREST HILLS NY
11375-6587
US

IV. Provider business mailing address

8530 262ND ST
FLORAL PARK NY
11001-1128
US

V. Phone/Fax

Practice location:
  • Phone: 347-255-2087
  • Fax:
Mailing address:
  • Phone: 357-255-2087
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number002281
License Number StateNY
# 2
Primary TaxonomyN
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number081087
License Number StateNY

VIII. Authorized Official

Name: MS. KRISTIE DOHENY
Title or Position: PSYCHOTHERAPIST
Credential: LMHC, LMSW
Phone: 347-255-2087