Provider Demographics
NPI:1265292841
Name:HOLISTIC HEALING FOR THE MIND AND SOUL, LLC
Entity type:Organization
Organization Name:HOLISTIC HEALING FOR THE MIND AND SOUL, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:LICENSE CLINICAL SOCIAL WORKER
Authorized Official - Prefix:MS
Authorized Official - First Name:BROOKE
Authorized Official - Middle Name:SHANEL
Authorized Official - Last Name:LEE
Authorized Official - Suffix:
Authorized Official - Credentials:LCSW
Authorized Official - Phone:804-480-9104
Mailing Address - Street 1:46 PINE DR
Mailing Address - Street 2:
Mailing Address - City:WHITE STONE
Mailing Address - State:VA
Mailing Address - Zip Code:22578-2641
Mailing Address - Country:US
Mailing Address - Phone:804-480-9104
Mailing Address - Fax:
Practice Address - Street 1:46 PINE DR
Practice Address - Street 2:
Practice Address - City:WHITE STONE
Practice Address - State:VA
Practice Address - Zip Code:22578-2641
Practice Address - Country:US
Practice Address - Phone:804-480-9104
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-03-20
Last Update Date:2024-04-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Single Specialty