Healthcare Provider Details

I. General information

NPI: 1326854472
Provider Name (Legal Business Name): ALLISON CLAIRE HOLDER SUDRC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/04/2024
Last Update Date: 07/31/2025
Certification Date: 07/31/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

306 SPRUCE AVE
SOUTH SAN FRANCISCO CA
94080-2741
US

IV. Provider business mailing address

67 41ST AVE APT 4
SAN MATEO CA
94403-5156
US

V. Phone/Fax

Practice location:
  • Phone: 650-589-9305
  • Fax:
Mailing address:
  • Phone: 650-430-7384
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License Number22119
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code175T00000X
TaxonomyPeer Specialist
License NumberMPSS-MXZFHL
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: