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General NPI Number Information
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NPI Number | 1811407356
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Entity Type | Organization
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Legal Business Name | HOLO WELLNESS LLC
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Dates
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Enumeration Date | 10/11/2017
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Last Update Date | 10/11/2017
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Provider Practice Location Address
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Address Line | 5401 S KIRKMAN RD STE 310
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City | ORLANDO
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State | FL
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Zip | 32819-7937
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Country | US
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Telephone | 407-839-9152
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Fax |
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Provider Business Mailing Address
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Address Line | 7813 SUGAR BROOK CT
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City | ORLANDO
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State | FL
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Zip | 32819-7210
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Country | US
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Telephone | 773-484-8538
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Fax |
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Authorized Official
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Title or Position | OWNER/PSYCHOTHERAPIST
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Name | MRS. ASHLEY NICOLE MORRIS
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Credential | LCSW
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Telephone | 407-839-9152
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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 | SW14831
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License Number State | FL
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