Provider Demographics
NPI:1699481937
Name:EMBODIED HOLISTIC HEALING LLC
Entity type:Organization
Organization Name:EMBODIED HOLISTIC HEALING LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:SAMANTHA
Authorized Official - Middle Name:JO
Authorized Official - Last Name:STANEK
Authorized Official - Suffix:
Authorized Official - Credentials:LPC
Authorized Official - Phone:248-342-0191
Mailing Address - Street 1:PO BOX 80484
Mailing Address - Street 2:
Mailing Address - City:ROCHESTER
Mailing Address - State:MI
Mailing Address - Zip Code:48308-0484
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:144 WOODVIEW CT APT 374
Practice Address - Street 2:
Practice Address - City:ROCHESTER HILLS
Practice Address - State:MI
Practice Address - Zip Code:48307-6304
Practice Address - Country:US
Practice Address - Phone:248-342-0191
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-01-30
Last Update Date:2023-01-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health