Healthcare Provider Details

I. General information

NPI: 1588261929
Provider Name (Legal Business Name): HOLISTIC WELLNESS SOLUTIONS LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/08/2020
Last Update Date: 01/30/2023
Certification Date: 01/30/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4770 INDIANOLA AVE STE 107
COLUMBUS OH
43214-1862
US

IV. Provider business mailing address

4770 INDIANOLA AVE STE 107
COLUMBUS OH
43214-1862
US

V. Phone/Fax

Practice location:
  • Phone: 614-371-2303
  • Fax: 800-905-9950
Mailing address:
  • Phone: 614-371-2303
  • Fax: 800-905-9950

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code261QM0801X
TaxonomyMental Health Clinic/Center (Including Community Mental Health Center)
License Number
License Number State

VIII. Authorized Official

Name: ALICJA MATUSIAK
Title or Position: OWNER/PROVIDER
Credential: LISW-S, PMHNP-BC
Phone: 614-371-2303