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

Laboratory Demographics

CLIA Number: 51D2143238

Facility Name: HOLISTIC, INC MEDICAL SERVICES AND COUNSELING

Facility Address:
4815 MACCORKLE AVE, SE
CHARLESTON, WV
ZIP 25304
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Facility Phone Number: 681 265-1693

Facility Type: Practitioner Other

Certificate Type: Waiver
NPI Number: 1811405616

Taxonomy: 207Q00000X - Family Medicine
Family Medicine is the medical specialty which is concerned with the total health care of the individual and the family. It is the specialty in breadth which integrates the biological, clinical, and behavioral sciences. The scope of family medicine is not limited by age, sex, organ system, or disease entity.

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
CertificateType 4
CertificateEffectiveDate 12/15/2022
CertificateExpirationDate 12/14/2024
FacilityType Waiver

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This page was last updated on: 4/23/2024