MEDICARE: BREATHE HOLISTIC COUNSELING

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	1041C0700X	Clinical Social Worker

General Provider Information

NPI Number	:	1649738501
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	BREATHE HOLISTIC COUNSELING

Provider Business Mailing Address
First Line	:	2818 EVERGREEN AVE
Second Line	:
City	:	BALTIMORE
State	:	MD
Zip	:	21214-1735
Country	:	US
Telephone Number	:	443-413-6830
Fax Number	:	410-444-6824

Provider Business Practice Location Address
First Line	:	2818 EVERGREEN AVE
Second Line	:
City	:	BALTIMORE
State	:	MD
Zip	:	21214-1735
Country	:	US
Telephone Number	:	443-413-6830
Fax Number	:

Authorized Official
Title or Position	:	PRESIDENT/PSYCHOTHERAPIST
Name	:	DR. DOROTHY ESTELLA ADAMSON HOLLEY
Credential	:	PHD, LCSW-C
Telephone Number	:	443-413-6830

Provider Enumeration Date	:	03/08/2019
Last Update Date	:	05/10/2019

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