51D2143238 CLIA NUMBER - HOLISTIC, INC MEDICAL SERVICES AND COUNSELING

Laboratory Demographics

  • CLIA Code: 51D2143238
  • Facility Name: HOLISTIC, INC MEDICAL SERVICES AND COUNSELING
  • Facility Address: 4815 MACCORKLE AVE, SE
    CHARLESTON, WV
    ZIP 25304
  • Facility Phone: 681 265-1693
  • Facility Type: Practitioner Other
  • Facility Type: Waiver
  • Lab Director: SHAWN R. BLANKENSHIP
  • NPI Number: 1811405616
  • Taxonomy: 207Q00000X - Family Medicine

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CLIA Record

Field Name Field Value
CLIA Number 51D2143238
LAB Type Practitioner Other
Facility Name HOLISTIC, INC MEDICAL SERVICES AND COUNSELING
Street 4815 MACCORKLE AVE, SE
City CHARLESTON
State WV
ZIP 25304
Phone 681 265-1693
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 12/15/2024
Certificate Expiration Date 12/14/2026
Facility Type Practitioner Other
Lab Director SHAWN R. BLANKENSHIP

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This page was last updated on: 9/29/2025