Healthcare Provider Details

I. General information

NPI: 1255885323
Provider Name (Legal Business Name): HOLISTIC SERVICES LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/06/2016
Last Update Date: 03/10/2021
Certification Date: 03/10/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1971 EAST PEMBROKE AVENUE ANNEX B
HAMPTON VA
23663-1338
US

IV. Provider business mailing address

1585 BRIARFIELD RD APT 38
HAMPTON VA
23666-4847
US

V. Phone/Fax

Practice location:
  • Phone: 757-790-6606
  • Fax: 757-838-7663
Mailing address:
  • Phone: 757-790-6606
  • Fax: 757-838-7663

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251S00000X
TaxonomyCommunity/Behavioral Health Agency
License Number2983
License Number StateVA

VIII. Authorized Official

Name: FAITH ANALISA WILLIAMS
Title or Position: CEO/OWNER
Credential: BSW
Phone: 757-770-2131