Healthcare Provider Details

I. General information

NPI: 1558476150
Provider Name (Legal Business Name): ANGELA HOLLAND M.S.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/21/2006
Last Update Date: 09/11/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1625 N 4TH ST SUITE 102C
COEUR D ALENE ID
83814-6178
US

IV. Provider business mailing address

1625 N 4TH ST SUITE 102C
COEUR D ALENE ID
83814-6178
US

V. Phone/Fax

Practice location:
  • Phone: 208-755-7198
  • Fax:
Mailing address:
  • Phone: 208-755-7198
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License Number10049
License Number StateID
# 2
Primary TaxonomyY
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License Number4419
License Number StateID

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: