MEDICARE: SONYA RENEE HOLLAND 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
1	101YP2500X	Professional Counselor	7012	NC

General Provider Information

NPI Number	:	1669657698
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	SONYA RENEE HOLLAND LPC

Provider Business Mailing Address
First Line	:	318 SPARROW DR
Second Line	:
City	:	FAYETTEVILLE
State	:	NC
Zip	:	28306-8227
Country	:	US
Telephone Number	:	910-308-3629
Fax Number	:	910-425-8614

Provider Business Practice Location Address
First Line	:	318 SPARROW DR
Second Line	:
City	:	FAYETTEVILLE
State	:	NC
Zip	:	28306-8227
Country	:	US
Telephone Number	:	910-308-3629
Fax Number	:	910-425-8614

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	01/09/2008
Last Update Date	:	07/01/2008

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