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General NPI Number Information
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NPI Number | 1023410131
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Entity Type | Organization
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Legal Business Name | HOLLY NABOZNY INC
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Dates
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Enumeration Date | 09/19/2014
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Last Update Date | 09/19/2014
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Provider Practice Location Address
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Address Line | 36389 HARPER AVE
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City | CLINTON TWP
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State | MI
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Zip | 48035-2958
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Country | US
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Telephone | 248-219-8756
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Fax |
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Provider Business Mailing Address
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Address Line | 119 RHODE ISLAND AVE
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City | ROYAL OAK
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State | MI
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Zip | 48067-3730
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Country | US
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Telephone | 248-219-8756
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Fax |
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Authorized Official
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Title or Position | PRESIDENT
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Name | HOLLY NABOZNY
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Credential |
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Telephone | 248-219-8756
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1041C0700X
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Taxonomy Name | Clinical Social Worker
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License Number | 6801090910
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License Number State | MI
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