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General NPI Number Information
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NPI Number | 1063798106
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Entity Type | Organization
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Legal Business Name | WITHIN HOLISTIC COUNSELING
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Dates
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Enumeration Date | 11/02/2011
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Last Update Date | 11/15/2021
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Provider Practice Location Address
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Address Line | 665 W JACKSON ST STE 2
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City | WOODSTOCK
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State | IL
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Zip | 60098-3187
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Country | US
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Telephone | 865-297-5077
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Fax |
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Provider Business Mailing Address
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Address Line | 200 MIDLAKE DR STE C
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City | KNOXVILLE
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State | TN
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Zip | 37918-3089
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Country | US
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Telephone | 865-985-1084
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | CELESTE MARIE BALLARD
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Credential | MA, LCPC
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Telephone | 865-985-1084
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 101YP2500X
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Taxonomy Name | Professional Counselor
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License Number | LCPC 180007509
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License Number State | IL
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