MEDICARE: HOLISTIC HEALTH ADVANCEMENTS, LLC

Medicare Provider Information

Scope of Practice

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

#	Taxonomy Code	Taxonomy
1	101Y00000X	Counselor
2	251E00000X	Home Health Agency
3	253Z00000X	In Home Supportive Care Agency
4	261QM1300X	Multi-Specialty Clinic/Center

General Provider Information

NPI Number	:	1942788542
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	HOLISTIC HEALTH ADVANCEMENTS, LLC

Provider Business Mailing Address
First Line	:	9005 TWO NOTCH RD STE 4
Second Line	:
City	:	COLUMBIA
State	:	SC
Zip	:	29223-5851
Country	:	US
Telephone Number	:	803-205-5395
Fax Number	:

Provider Business Practice Location Address
First Line	:	9005 TWO NOTCH RD STE 4
Second Line	:
City	:	COLUMBIA
State	:	SC
Zip	:	29223-5851
Country	:	US
Telephone Number	:	803-205-5395
Fax Number	:	803-621-1526

Authorized Official
Title or Position	:	CEO
Name	:	DR. MELISSA MULLINS
Credential	:	EDD
Telephone Number	:	803-205-5395

Provider Enumeration Date	:	08/06/2018
Last Update Date	:	12/13/2018

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