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NPI Code Detail

MEDICARE: HATTIE NICHOLE HOLLAND MA, NCC, LPC

MEDICARE: HATTIE NICHOLE HOLLAND MA, NCC, LPC
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1101YP2500XProfessional Counselor178.014712IL

General Provider Information

NPI Number : 1134761794
Entity Type Code : Individual
Provider Name (Legal Business Name) : HATTIE NICHOLE HOLLAND MA, NCC, LPC
Provider Business Mailing Address
First Line : 1731 N MARCEY ST STE 510
Second Line :
City : CHICAGO
State : IL
Zip : 60614-7955
Country : US
Telephone Number : 815-641-8503
Fax Number :
Provider Business Practice Location Address
First Line : 1731 N MARCEY ST STE 510
Second Line :
City : CHICAGO
State : IL
Zip : 60614-7955
Country : US
Telephone Number : 815-641-8503
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 10/15/2019
Last Update Date : 10/15/2019

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