Holistic Wellness & Support LLC.

Primary specialty

Clinical Social WorkerTaxonomy code 1041C0700X

Legal business name

HOLISTIC WELLNESS & SUPPORT LLC.

Practice address

8101 Sandy Spring Rd Ste 300
Laurel, MD 20707-3596

Phone

(301) 909-3887

NPI assigned

Jun 12, 2021

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Mr. Carlton Gilbert Fonville, LCSW-C

Title

Executive Director

Phone

(301) 909-3887

Specialties & licenses 9

Addresses

Other identifiers 1

Electronic endpoints 1

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1623456000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1646611200000",
    "number": "1427626837",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "8101 SANDY SPRING RD STE 300",
            "city": "LAUREL",
            "state": "MD",
            "postal_code": "207073596",
            "telephone_number": "301-909-3887",
            "fax_number": "443-279-2793"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "8101 SANDY SPRING RD STE 300",
            "city": "LAUREL",
            "state": "MD",
            "postal_code": "207073596",
            "telephone_number": "301-909-3887"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "HOLISTIC WELLNESS & SUPPORT LLC.",
        "organizational_subpart": "NO",
        "enumeration_date": "2021-06-12",
        "last_updated": "2022-03-07",
        "certification_date": "2021-08-03",
        "status": "A",
        "authorized_official_last_name": "FONVILLE",
        "authorized_official_first_name": "CARLTON",
        "authorized_official_middle_name": "GILBERT",
        "authorized_official_title_or_position": "EXECUTIVE DIRECTOR",
        "authorized_official_telephone_number": "301-909-3887",
        "authorized_official_name_prefix": "Mr.",
        "authorized_official_credential": "LCSW-C"
    },
    "taxonomies": [
        {
            "code": "101YA0400X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Counselor, Addiction (Substance Use Disorder)",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "101YM0800X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Counselor, Mental Health",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "101YP2500X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Counselor, Professional",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "103K00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Behavior Analyst",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "1041C0700X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Social Worker, Clinical",
            "state": null,
            "license": null,
            "primary": true
        },
        {
            "code": "1041S0200X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Social Worker, School",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "106H00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Marriage & Family Therapist",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "171400000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Health & Wellness Coach",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "171M00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Case Manager/Care Coordinator",
            "state": null,
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "NONE",
            "identifier": "NONE",
            "state": "MD"
        }
    ],
    "endpoints": [
        {
            "endpointType": "CONNECT",
            "endpointTypeDescription": "CONNECT URL",
            "endpoint": "holwellnesssupport.org",
            "affiliation": "N",
            "endpointDescription": "Office Location",
            "use": "DIRECT",
            "useDescription": "Direct",
            "contentType": "CSV",
            "contentTypeDescription": "CSV",
            "address_1": "8101 Sandy Spring Rd Ste 300",
            "city": "Laurel",
            "state": "MD",
            "country_code": "US",
            "postal_code": "207073596",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

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• Holistic Wellness Services LLC
• Corey Holloway, OT
• Holmes Counseling Services
• Kevin John Holmes, LCSW
• Home Life Help Services, LLC

• Clinical Social Worker in Laurel, MD
• Providers in Laurel, MD by specialty
• Clinical Social Worker in Maryland

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 7, 2022; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.