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General NPI Number Information
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NPI Number | 1104059328
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Entity Type | Organization
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Legal Business Name | TRINITY WHOLISTIC HEALING SERVICES
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Dates
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Enumeration Date | 09/04/2009
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Last Update Date | 09/04/2009
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Provider Practice Location Address
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Address Line | 1701 ENTERPRISE RD
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City | MITCHELLVILLE
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State | MD
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Zip | 20721-2213
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Country | US
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Telephone | 301-442-1990
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Fax | 301-627-1806
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Provider Business Mailing Address
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Address Line | 16314 BOSWELL PL
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City | UPPER MARLBORO
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State | MD
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Zip | 20772-3286
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Country | US
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Telephone | 301-442-1990
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Fax | 301-627-1806
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Authorized Official
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Title or Position | OWNER
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Name | AUDRA N GILLIS
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Credential | MSW, LICSW
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Telephone | 301-442-1990
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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 | 13071
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License Number State | MD
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