Healthcare Provider Details

I. General information

NPI: 1629046891
Provider Name (Legal Business Name): WILLILAM F. HOLLAND LICSW
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/14/2006
Last Update Date: 01/06/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

701 DECATUR AVE N STE 109
GOLDEN VALLEY MN
55427-4363
US

IV. Provider business mailing address

1109 QUEBEC AVE N
GOLDEN VALLEY MN
55427-4517
US

V. Phone/Fax

Practice location:
  • Phone: 763-746-2400
  • Fax: 763-746-2401
Mailing address:
  • Phone: 763-537-6359
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number11534
License Number StateMN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: