Healthcare Provider Details

I. General information

NPI: 1831151463
Provider Name (Legal Business Name): HOLISTIC MENTAL HEALTH INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/06/2006
Last Update Date: 04/10/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2211 TODDS LANE
HAMPTON VA
23666
US

IV. Provider business mailing address

PO BOX 8084
HAMPTON VA
23666
US

V. Phone/Fax

Practice location:
  • Phone: 757-826-2514
  • Fax: 757-826-5560
Mailing address:
  • Phone: 757-826-2514
  • Fax: 757-826-5560

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QM0801X
TaxonomyMental Health Clinic/Center (Including Community Mental Health Center)
License Number
License Number State

VIII. Authorized Official

Name: CLARA ELIZABETH EWING
Title or Position: DIRECTOR PRESIDENT HOLISTIC MENTAL
Credential: LMFT LPC CSAC
Phone: 757-826-2514