Healthcare Provider Details

I. General information

NPI: 1316779788
Provider Name (Legal Business Name): HOLISTIC HEALING: MIND BODY SPIRIT
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/15/2024
Last Update Date: 08/15/2024
Certification Date: 08/15/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10 JARRETT ST
ELKVIEW WV
25071-9217
US

IV. Provider business mailing address

3501 MACCORKLE AVE SE # 126
CHARLESTON WV
25304-1419
US

V. Phone/Fax

Practice location:
  • Phone: 304-814-3179
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QM0850X
TaxonomyAdult Mental Health Clinic/Center
License Number
License Number StateNULL
# 2
Primary TaxonomyN
Taxonomy Code251S00000X
TaxonomyCommunity/Behavioral Health Agency
License Number
License Number StateNULL

VIII. Authorized Official

Name: ANGEL HILES
Title or Position: OWNER/CLINICAL THERAPIST
Credential:
Phone: 304-814-3179