| Holistic Life Enrichment, Pllc | |
|
109 Professional Park Dr Ste 100 Mooresville NC 28117-5538 | |
| (704) 412-7502 | |
| Not Available |
| Full Name | Holistic Life Enrichment, Pllc |
|---|---|
| Speciality | Social Worker |
| Location | 109 Professional Park Dr Ste 100, Mooresville, North Carolina |
| Authorized Official Name and Position | Kristina Richendollar (OWNER/ORGANIZER) |
| Authorized Official Contact | 7044127502 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Holistic Life Enrichment, Pllc 120 Pamlico Ln Mooresville NC 28117-5957 Ph: (260) 403-5198 | Holistic Life Enrichment, Pllc 109 Professional Park Dr Ste 100 Mooresville NC 28117-5538 Ph: (704) 412-7502 |
| NPI Number | 1679215024 |
|---|---|
| Provider Enumeration Date | 04/07/2022 |
| Last Update Date | 04/07/2022 |
| Certification Date | 04/07/2022 |
| Medicare PECOS PAC ID | 8325429954 |
|---|---|
| Medicare Enrollment ID | O20220713004287 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1679215024 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 1041C0700X | Social Worker - Clinical | (* (Not Available)) | Primary |
| Provider Name | Kristina Richendollar |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1306375209 PECOS PAC ID: 7214333145 Enrollment ID: I20210901001159 |
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