Healthcare Provider Details

I. General information

NPI: 1811929995
Provider Name (Legal Business Name): DONALD EUGENE HOLLAND LMFT
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/07/2006
Last Update Date: 05/15/2023
Certification Date: 05/15/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

104 CAMBRIDGE PLAZA DR
WINSTON SALEM NC
27104-3556
US

IV. Provider business mailing address

713 S MARSHALL ST
WINSTON SALEM NC
27101-5808
US

V. Phone/Fax

Practice location:
  • Phone: 336-722-7266
  • Fax: 336-201-0538
Mailing address:
  • Phone: 336-722-7266
  • Fax: 336-201-0538

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License Number1050
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: