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General NPI Number Information
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NPI Number | 1356515167
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Entity Type | Organization
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Legal Business Name | SKYEIA HOLISTIC SERVICES, LLC
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Dates
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Enumeration Date | 04/14/2008
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Last Update Date | 12/16/2010
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Provider Practice Location Address
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Address Line | 315 DAWSON AVE STE C
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City | OAKLAND
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State | MD
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Zip | 21550-5113
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Country | US
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Telephone | 240-321-2487
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Fax | 301-334-5922
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Provider Business Mailing Address
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Address Line | 1138 EAGLE ROCK RD
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City | OAKLAND
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State | MD
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Zip | 21550-6825
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Country | US
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Telephone | 240-321-2487
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Fax | 301-334-5922
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Authorized Official
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Title or Position | CEO
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Name | MELISA M CARRICO
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Credential | LCPC
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Telephone | 240-321-2487
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 101YM0800X
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Taxonomy Name | Mental Health Counselor
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License Number | LC1331
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License Number State | MD
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