=====================================================
General NPI Number Information
=====================================================
NPI Number | 1346042348
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | HOLISTIC INTERNATIONAL MINISTRIES (DBA, HIM.,INC.)
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 03/27/2025
-----------------------------------------------------
Last Update Date | 03/27/2025
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 1015 TYRONE RD STE 420
-----------------------------------------------------
City | TYRONE
-----------------------------------------------------
State | GA
-----------------------------------------------------
Zip | 30290-2456
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 470-900-7361
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 1015 TYRONE RD STE 420
-----------------------------------------------------
City | TYRONE
-----------------------------------------------------
State | GA
-----------------------------------------------------
Zip | 30290-2456
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 470-900-7361
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | CEO-FOUNDER
-----------------------------------------------------
Name | DR. LYNN PAIGE
-----------------------------------------------------
Credential | LPC
-----------------------------------------------------
Telephone | 470-900-7361
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 103TH0100X
-----------------------------------------------------
Taxonomy Name | Health Service Psychologist
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------