MEDICARE: HOLISTIC INSPIRATION, LLC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	101YP2500X	Professional Counselor

General Provider Information

NPI Number	:	1598402810
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	HOLISTIC INSPIRATION, LLC

Provider Business Mailing Address
First Line	:	2126 ROBIN HOOD DR
Second Line	:
City	:	DANVILLE
State	:	VA
Zip	:	24540-5802
Country	:	US
Telephone Number	:	434-822-3698
Fax Number	:

Provider Business Practice Location Address
First Line	:	2126 ROBIN HOOD DR
Second Line	:
City	:	DANVILLE
State	:	VA
Zip	:	24540-5802
Country	:	US
Telephone Number	:	434-822-3698
Fax Number	:

Authorized Official
Title or Position	:	OWNER
Name	:	CHARNELL BROWN
Credential	:	LPC, LCMHC
Telephone Number	:	434-822-3698

Provider Enumeration Date	:	05/18/2022
Last Update Date	:	05/23/2022

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