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General NPI Number Information
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NPI Number | 1013884436
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Entity Type | Organization
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Legal Business Name | HOLISTIC THERAPY AND LIFE COACHING LLC
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Dates
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Enumeration Date | 10/21/2025
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Last Update Date | 12/03/2025
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Provider Practice Location Address
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Address Line | 200 WASHINGTON ST STE 205
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City | WATERTOWN
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State | NY
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Zip | 13601-3335
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Country | US
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Telephone | 315-775-8838
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Fax | 315-800-6487
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Provider Business Mailing Address
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Address Line | 25419 HUNTLEY LN
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City | CARTHAGE
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State | NY
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Zip | 13619-7502
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Country | US
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Telephone | 615-424-3912
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Fax | 315-800-6487
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Authorized Official
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Title or Position | OWNER
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Name | MRS. JACQUELINE MALCOLM
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Credential | LCSW
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Telephone | 615-424-3912
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1041C0700X
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Taxonomy Name | Clinical Social Worker
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License Number |
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License Number State |
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