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General NPI Number Information
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NPI Number | 1811677438
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Entity Type | Organization
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Legal Business Name | HOLISTIC BEHAVIORAL HEALTHCARE LLC
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Dates
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Enumeration Date | 07/19/2023
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Last Update Date | 07/19/2023
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Provider Practice Location Address
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Address Line | 1721 BROAD ST
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City | SELMA
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State | AL
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Zip | 36701-4116
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Country | US
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Telephone | 513-238-0267
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Fax |
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Provider Business Mailing Address
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Address Line | 1721 BROAD ST
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City | SELMA
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State | AL
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Zip | 36701-4116
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | MANAGING ONWER
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Name | CARINE DJUIDJE
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Credential | NP
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Telephone | 513-238-0267
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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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