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General NPI Number Information
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NPI Number | 1740587153
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Entity Type | Organization
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Legal Business Name | HOLISTIC HEALTH CENTER FOR PERSONAL GROWTH AND HEALING
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Dates
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Enumeration Date | 02/21/2011
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Last Update Date | 02/21/2011
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Provider Practice Location Address
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Address Line | 7613 113TH ST
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City | FOREST HILLS
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State | NY
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Zip | 11375-6587
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Country | US
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Telephone | 347-255-2087
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Fax |
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Provider Business Mailing Address
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Address Line | 8530 262ND ST
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City | FLORAL PARK
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State | NY
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Zip | 11001-1128
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Country | US
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Telephone | 357-255-2087
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Fax |
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Authorized Official
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Title or Position | PSYCHOTHERAPIST
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Name | MS. KRISTIE DOHENY
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Credential | LMHC, LMSW
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Telephone | 347-255-2087
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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 | 081087
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License Number State | NY
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Taxonomy #2
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Taxonomy Code | 101YM0800X
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Taxonomy Name | Mental Health Counselor
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License Number | 002281
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License Number State | NY
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