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General NPI Number Information
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NPI Number | 1932639663
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Entity Type | Organization
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Legal Business Name | HOLISTIC TREATMENT CENTER
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Dates
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Enumeration Date | 06/15/2017
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Last Update Date | 06/15/2017
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Provider Practice Location Address
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Address Line | 3050 CRAIN HWY STE 200
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City | WALDORF
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State | MD
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Zip | 20601-2822
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Country | US
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Telephone | 571-490-1421
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Fax | 571-490-1421
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Provider Business Mailing Address
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Address Line | 12301 LOCH CARRON CIR
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City | FORT WASHINGTON
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State | MD
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Zip | 20744-7017
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Country | US
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Telephone | 571-490-1421
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Fax |
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Authorized Official
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Title or Position | PRESIDENT
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Name | RENEE BUTLER
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Credential | LCSW-CQ
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Telephone | 571-490-1421
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261Q00000X
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Taxonomy Name | Clinic/Center
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License Number | 20563
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License Number State | MD
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