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General NPI Number Information
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NPI Number | 1891198925
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Entity Type | Organization
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Legal Business Name | WHOLISTIC LIVING, LLC
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Dates
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Enumeration Date | 10/03/2014
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Last Update Date | 09/08/2015
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Provider Practice Location Address
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Address Line | 1035 EMMORTON ROAD
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City | BEL AIR
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State | MD
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Zip | 21014
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Country | US
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Telephone | 410-937-1386
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Fax |
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Provider Business Mailing Address
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Address Line | 2410 CHATAU CT
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City | FALLSTON
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State | MD
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Zip | 21047-2318
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Country | US
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Telephone | 410-937-1386
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Fax |
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Authorized Official
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Title or Position | DIRECTOR
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Name | SHELBY J JOHN
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Credential |
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Telephone | 410-937-1386
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 101YM0800X
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Taxonomy Name | Mental Health Counselor
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License Number | 13592
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License Number State | MD
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