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General NPI Number Information
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NPI Number | 1619239779
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Entity Type | Organization
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Legal Business Name | HOLISTIC THERAPEUTIC ARTS LLC
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Dates
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Enumeration Date | 06/13/2012
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Last Update Date | 06/13/2012
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Provider Practice Location Address
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Address Line | 3580 INDIAN QUEEN LN
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City | PHILADELPHIA
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State | PA
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Zip | 19129-1540
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Country | US
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Telephone | 215-360-3489
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Fax |
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Provider Business Mailing Address
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Address Line | 35 W MOUNT AIRY AVE
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City | PHILADELPHIA
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State | PA
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Zip | 19119-2402
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Country | US
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Telephone | 215-360-3489
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | MARY RAGLAND
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Credential | LCSW
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Telephone | 215-360-3489
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1041C0700X
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Taxonomy Name | Clinical Social Worker
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License Number | CW016368
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License Number State | PA
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