Healthcare Provider Details

I. General information

NPI: 1386150902
Provider Name (Legal Business Name): MICHAEL HOLLAND LCSW
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/19/2017
Last Update Date: 12/19/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3471 OHIO RIVER ROAD
POINT PLEASANT WV
25550
US

IV. Provider business mailing address

PO BOX 457
BEAVER PA
15009-0457
US

V. Phone/Fax

Practice location:
  • Phone: 304-812-5965
  • Fax: 304-812-5961
Mailing address:
  • Phone: 724-660-4159
  • Fax: 724-660-4233

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code104100000X
TaxonomySocial Worker
License NumberCP00943198
License Number StateWV

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: