Organization
HOLISTIC WELLNESS & SUPPORT LLC.
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MR. CARLTON GILBERT FONVILLE LCSW-C (EXECUTIVE DIRECTOR)
(301) 909-3887
Entity
Organization
Contact information
Practice address
8101 SANDY SPRING RD STE 300, LAUREL, MD 20707-3596
(301) 909-3887
Mailing address
8101 SANDY SPRING RD STE 300, LAUREL, MD 20707-3596
(301) 909-3887
(443) 279-2793
Taxonomy
Speciality
Code
Description
License number
State
101YA0400X
Addiction (Substance Use Disorder) Counselor
—
—
101YM0800X
Mental Health Counselor
—
—
101YP2500X
Professional Counselor
—
—
103K00000X
Behavior Analyst
—
—
1041C0700X
Clinical Social Worker
Primary
—
—
1041S0200X
School Social Worker
—
—
106H00000X
Marriage & Family Therapist
—
—
171400000X
Health & Wellness Coach
—
—
171M00000X
Case Manager/Care Coordinator
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
NONE
NONE
MD
Enumeration date
06/12/2021
Last updated
03/07/2022
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