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General NPI Number Information
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NPI Number | 1558069187
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Entity Type | Organization
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Legal Business Name | HOLISTIKA LLC.
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Dates
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Enumeration Date | 02/22/2023
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Last Update Date | 02/22/2023
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Provider Practice Location Address
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Address Line | 3074 W LAKE MARY BLVD STE 132
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City | LAKE MARY
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State | FL
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Zip | 32746-6749
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Country | US
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Telephone | 407-333-0404
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Fax |
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Provider Business Mailing Address
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Address Line | 414 MOHAVE TER
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City | LAKE MARY
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State | FL
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Zip | 32746-7009
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Country | US
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Telephone | 908-380-6643
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Fax |
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Authorized Official
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Title or Position | MENTAL HEALTH COUNSELOR
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Name | MRS. JOSSIE THURMAN
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Credential | MS, RMHCI
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Telephone | 407-455-0529
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 251S00000X
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Taxonomy Name | Community/Behavioral Health Agency
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License Number |
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License Number State |
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