Provider Demographics
NPI:1609587120
Name:HOLISTIC WELLNESS SERVICES
Entity type:Organization
Organization Name:HOLISTIC WELLNESS SERVICES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO / FOUNDER
Authorized Official - Prefix:
Authorized Official - First Name:VICKIE
Authorized Official - Middle Name:
Authorized Official - Last Name:COOKE
Authorized Official - Suffix:
Authorized Official - Credentials:LCADC
Authorized Official - Phone:443-629-0646
Mailing Address - Street 1:PO BOX 3394
Mailing Address - Street 2:
Mailing Address - City:BALTIMORE
Mailing Address - State:MD
Mailing Address - Zip Code:21213-0394
Mailing Address - Country:US
Mailing Address - Phone:443-629-0646
Mailing Address - Fax:
Practice Address - Street 1:3806 RAVENWOOD AVE
Practice Address - Street 2:
Practice Address - City:BALTIMORE
Practice Address - State:MD
Practice Address - Zip Code:21213-2022
Practice Address - Country:US
Practice Address - Phone:443-629-0646
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-12-06
Last Update Date:2022-12-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes261QM0850XAmbulatory Health Care FacilitiesClinic/CenterAdult Mental Health
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)Group - Multi-Specialty
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Multi-Specialty