MEDICARE: HOLSAN BEHAVIORAL HEALTH

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	261QM0801X	Mental Health Clinic/Center (Including Community Mental Health Center)

General Provider Information

NPI Number	:	1629848619
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	HOLSAN BEHAVIORAL HEALTH

Provider Business Mailing Address
First Line	:	1631 MIDTOWN PL STE 104-110
Second Line	:
City	:	RALEIGH
State	:	NC
Zip	:	27609-1300
Country	:	US
Telephone Number	:	336-355-2142
Fax Number	:

Provider Business Practice Location Address
First Line	:	4946 WINDY HILL DR STE A
Second Line	:
City	:	RALEIGH
State	:	NC
Zip	:	27609-5188
Country	:	US
Telephone Number	:	336-355-2142
Fax Number	:	336-863-1925

Authorized Official
Title or Position	:	OWNER
Name	:	MRS. ADRIENNE HOLLOWAY
Credential	:	RN
Telephone Number	:	336-355-2142

Provider Enumeration Date	:	01/02/2024
Last Update Date	:	01/27/2026

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