Doctor Name: | ANDRINA HOLLIS |
NPI Number: | 1245625920 |
Entity Type Code: | Individual (1) |
Gender: | F |
Credentials: | LPC |
License Number: | 6401009892 |
Business Practice Address: | 801 Hazen St Paw Paw, MI - 490792008 |
Business Phone Number: | 2696553334 |
Business Fax Number: | 2696576523 |
Mailing Address: | 801 Hazen St, PAW PAW |
State: | MI |
Postal Code: | 490792008 |
Phone Number: | 2696553334 |
Fax Number: | 2696576523 |
NPI Enumeration Date: | 03/31/2015 |
NPI Last Update Date: | 03/31/2015 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 101YP2500X |
License Number: | 6401009892 |
Healthcare Provider Taxonomy: (Secondary) | Y |
State: | MI |
Taxonomy Type: | Behavioral Health & Social Service Providers |
Taxonomy Classification: | Counselor |
Taxonomy Specialization: | Professional |
Taxonomy Definition: |