Provider Demographics
NPI:1174094593
Name:WHOLE FAMILY HEALING GROUP, LLC
Entity type:Organization
Organization Name:WHOLE FAMILY HEALING GROUP, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CLINICAL SOCIAL WORKER/OWNER
Authorized Official - Prefix:
Authorized Official - First Name:MIESHA
Authorized Official - Middle Name:
Authorized Official - Last Name:RICE
Authorized Official - Suffix:
Authorized Official - Credentials:LCSW-C
Authorized Official - Phone:443-979-3295
Mailing Address - Street 1:1325 BEDFORD AVE UNIT 32405
Mailing Address - Street 2:
Mailing Address - City:PIKESVILLE
Mailing Address - State:MD
Mailing Address - Zip Code:21282-7550
Mailing Address - Country:US
Mailing Address - Phone:443-979-3295
Mailing Address - Fax:
Practice Address - Street 1:104 CHURCH LN STE 120
Practice Address - Street 2:
Practice Address - City:PIKESVILLE
Practice Address - State:MD
Practice Address - Zip Code:21208-3786
Practice Address - Country:US
Practice Address - Phone:410-413-6043
Practice Address - Fax:410-559-6510
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-12-11
Last Update Date:2021-01-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Multi-Specialty
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Multi-Specialty
No251S00000XAgenciesCommunity/Behavioral HealthGroup - Multi-Specialty
No261QM0801XAmbulatory Health Care FacilitiesClinic/CenterMental Health (Including Community Mental Health Center)
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD654086400Medicaid
MD1174094593OtherNPPES NPI 2
MD1598204620OtherNPPES NPI 1
MD19531OtherCLINICAL SOCIAL WORK LICENSE NUMBER