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General NPI Number Information
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NPI Number | 1467125104
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Entity Type | Organization
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Legal Business Name | ETW THERAPEUTIC & HOLISTIC SERVICES LLC
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Dates
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Enumeration Date | 07/28/2021
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Last Update Date | 11/07/2024
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Provider Practice Location Address
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Address Line | 7305 BALTIMORE AVE # A101
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City | COLLEGE PARK
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State | MD
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Zip | 20740-3234
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Country | US
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Telephone | 202-743-5660
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Fax |
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Provider Business Mailing Address
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Address Line | 7206 SHOCKLEY CT
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City | FORT WASHINGTON
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State | MD
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Zip | 20744-1711
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Country | US
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Telephone | 202-743-5660
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Fax |
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Authorized Official
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Title or Position | PRESIDENT/CEO
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Name | DR. ERIC WHITAKER
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Credential | PHD, LCSW-C, LICSW
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Telephone | 202-743-5660
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QR0400X
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Taxonomy Name | Rehabilitation Clinic/Center
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 261QM0850X
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Taxonomy Name | Adult Mental Health Clinic/Center
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License Number |
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License Number State |
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