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NPI Code Detail

MEDICARE: TENNEH MAXINE HOLLINS LCDC

MEDICARE: TENNEH MAXINE HOLLINS LCDC
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
1101YA0400XAddiction (Substance Use Disorder) Counselor14309TX

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
114309OTHERTXLCDC

General Provider Information

NPI Number : 1346722303
Entity Type Code : Individual
Provider Name (Legal Business Name) : TENNEH MAXINE HOLLINS LCDC
Provider Business Mailing Address
First Line : 921 CRAWFORD ST APT 4209
Second Line :
City : FORT WORTH
State : TX
Zip : 76104-3483
Country : US
Telephone Number : 682-346-2049
Fax Number :
Provider Business Practice Location Address
First Line : 921 CRAWFORD ST APT 4209
Second Line :
City : FORT WORTH
State : TX
Zip : 76104-3483
Country : US
Telephone Number : 682-346-2049
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 09/05/2018
Last Update Date : 11/03/2023

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Directions to “ TENNEH MAXINE HOLLINS LCDC” Practice Location

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