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General NPI Number Information
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NPI Number | 1699357699
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Entity Type | Organization
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Legal Business Name | HOLISTIC TRACK INCORPORATED
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Dates
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Enumeration Date | 04/28/2021
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Last Update Date | 04/30/2021
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Provider Practice Location Address
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Address Line | 110 PAINTERS MILL RD STE 108B
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City | OWINGS MILLS
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State | MD
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Zip | 21117-4920
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Country | US
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Telephone | 240-552-0264
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Fax | 443-441-5081
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Provider Business Mailing Address
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Address Line | 2504 SOMERTON CT
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City | BOWIE
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State | MD
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Zip | 20721-2979
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Country | US
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Telephone | 240-552-0264
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Fax |
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Authorized Official
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Title or Position | PRESIDENT
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Name | EVARIST O OGUGUO
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Credential | PMHNP, DNP
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Telephone | 240-552-0264
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363LP0808X
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Taxonomy Name | Psychiatric/Mental Health Nurse Practitioner
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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 | 261QM0801X
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Taxonomy Name | Mental Health Clinic/Center (Including Community Mental Health Center)
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License Number |
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License Number State |
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