MEDICARE: MS. LINDSAY ERMINIA HOLLAND LADC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	101YA0400X	Addiction (Substance Use Disorder) Counselor	LADC 852-L	NV

General Provider Information

NPI Number	:	1124464193
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. LINDSAY ERMINIA HOLLAND LADC

Provider Business Mailing Address
First Line	:	PO BOX 10765
Second Line	:
City	:	RENO
State	:	NV
Zip	:	89510-0765
Country	:	US
Telephone Number	:	775-358-1123
Fax Number	:	775-358-9391

Provider Business Practice Location Address
First Line	:	420 S ROCK BLVD
Second Line	:
City	:	SPARKS
State	:	NV
Zip	:	89431-5547
Country	:	US
Telephone Number	:	775-358-1123
Fax Number	:	775-358-9391

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	05/17/2013
Last Update Date	:	05/17/2013

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