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General NPI Number Information
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NPI Number | 1659900488
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Entity Type | Organization
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Legal Business Name | HOLISTIC PSYCHOHEALTH SERVICES LLC
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Dates
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Enumeration Date | 04/03/2020
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Last Update Date | 06/01/2023
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Provider Practice Location Address
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Address Line | 632 FREDERICK RD # 200
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City | CATONSVILLE
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State | MD
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Zip | 21228-4696
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Country | US
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Telephone | 443-892-0553
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Fax |
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Provider Business Mailing Address
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Address Line | 632 FREDERICK RD # 200
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City | CATONSVILLE
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State | MD
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Zip | 21228-4696
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Country | US
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Telephone | 443-892-0553
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | GERMAINE AJAVON
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Credential | LCPC
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Telephone | 410-736-8010
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 101YP2500X
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Taxonomy Name | Professional Counselor
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License Number |
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License Number State |
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