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General NPI Number Information
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NPI Number | 1184086035
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Entity Type | Organization
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Legal Business Name | HOLISTIC THERAPY CENTER, LLC
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Dates
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Enumeration Date | 03/21/2016
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Last Update Date | 03/21/2016
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Provider Practice Location Address
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Address Line | 3461 UNIVERSITY AVE SUITE 102
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City | MORGANTOWN
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State | WV
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Zip | 26505-0351
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Country | US
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Telephone | 304-680-7003
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Fax |
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Provider Business Mailing Address
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Address Line | 3461 UNIVERSITY AVE SUITE 102
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City | MORGANTOWN
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State | WV
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Zip | 26505-0351
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | OWNER/THERAPIST
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Name | JAMIE DOWNS
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Credential | LICSW, MSW, AADC
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Telephone | 304-680-7003
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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 | DP00944084
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License Number State | WV
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