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General NPI Number Information
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NPI Number | 1275339632
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Entity Type | Organization
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Legal Business Name | HALL-SAMPLE HOLISTIC GROUP, LLC
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Dates
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Enumeration Date | 02/24/2025
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Last Update Date | 02/24/2025
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Provider Practice Location Address
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Address Line | 23472 JOHN CANE RD
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City | GREENBUSH
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State | VA
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Zip | 23357-2242
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Country | US
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Telephone | 757-709-5229
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Fax |
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Provider Business Mailing Address
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Address Line | 821 WHITE OAKS LN
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City | POCOMOKE CITY
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State | MD
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Zip | 21851-9589
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Country | US
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Telephone | 757-709-5229
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Fax |
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Authorized Official
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Title or Position | PROGRAM OPERATIONS MANAGER
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Name | MS. LANEEN SHANELLE WHITE
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Credential | MS.ED
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Telephone | 757-709-5229
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 405300000X
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Taxonomy Name | Prevention Professional
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License Number |
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License Number State |
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