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General NPI Number Information
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NPI Number | 1861766594
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Entity Type | Organization
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Legal Business Name | HOLISTICS SERVICES INC
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Dates
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Enumeration Date | 02/27/2012
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Last Update Date | 02/27/2012
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Provider Practice Location Address
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Address Line | 2003 GODWIN AVE STE C
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City | LUMBERTON
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State | NC
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Zip | 28358-3150
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Country | US
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Telephone | 910-739-2477
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Fax | 910-739-2478
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Provider Business Mailing Address
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Address Line | 2003 GODWIN AVE STE C
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City | LUMBERTON
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State | NC
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Zip | 28358-3150
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Country | US
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Telephone | 910-739-2477
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Fax | 910-739-2478
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Authorized Official
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Title or Position | CEO
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Name | MRS. KIA MCLEAN
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Credential | OWNER
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Telephone | 910-739-2477
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 101YA0400X
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Taxonomy Name | Addiction (Substance Use Disorder) Counselor
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License Number | 1277
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License Number State | NC
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Taxonomy #2
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Taxonomy Code | 101YA0400X
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Taxonomy Name | Addiction (Substance Use Disorder) Counselor
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License Number | 1665
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License Number State | NC
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