Healthcare Provider Details

I. General information

NPI: 1538609953
Provider Name (Legal Business Name): RAY HOLLAND II L.P.C, L.M.H.C.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/04/2017
Last Update Date: 03/04/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

25 SUNSET VIEW DR
HORSE SHOE NC
28742-7764
US

IV. Provider business mailing address

25 SUNSET VIEW DR
HORSE SHOE NC
28742-7764
US

V. Phone/Fax

Practice location:
  • Phone: 828-890-8340
  • Fax:
Mailing address:
  • Phone: 828-890-8340
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number10132
License Number StateNC
# 2
Primary TaxonomyN
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License NumberMH4323
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: