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General NPI Number Information
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NPI Number | 1568267037
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Entity Type | Organization
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Legal Business Name | HOLISTIC SPACE LLC
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Dates
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Enumeration Date | 02/18/2025
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Last Update Date | 02/18/2025
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Provider Practice Location Address
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Address Line | 5540 MCNEELY DR STE 101
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City | RALEIGH
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State | NC
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Zip | 27612
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Country | US
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Telephone | 689-261-1777
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Fax |
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Provider Business Mailing Address
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Address Line | 964 HIGH HOUSE RD
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City | CARY
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State | NC
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Zip | 27513-3574
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Country | US
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Telephone | 689-261-1777
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Fax |
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Authorized Official
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Title or Position | HOLISTIC PRACTITIONER
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Name | HEIDI MARQUEZ
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Credential |
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Telephone | 689-261-1777
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261Q00000X
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Taxonomy Name | Clinic/Center
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License Number |
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License Number State |
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