Basic Information
| Provider Information | |||||||||
| NPI: | 1083884654 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | HOLLAND | ||||||||
| FirstName: | ANDREA | ||||||||
| MiddleName: | R. | ||||||||
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| Credential: | LMHC | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1900 10TH ST | ||||||||
| Address2: | |||||||||
| City: | ALAMOGORDO | ||||||||
| State: | NM | ||||||||
| PostalCode: | 883105053 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5754377404 | ||||||||
| FaxNumber: | 5754392860 | ||||||||
| Practice Location | |||||||||
| Address1: | 206 SUDDERTH DR | ||||||||
| Address2: | |||||||||
| City: | RUIDOSO | ||||||||
| State: | NM | ||||||||
| PostalCode: | 883456001 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5752575038 | ||||||||
| FaxNumber: | 5752572312 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 03/10/2008 | ||||||||
| LastUpdateDate: | 03/10/2008 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 101YM0800X | 0089801 | NM | Y | Behavioral Health & Social Service Providers | Counselor | Mental Health |
No ID Information.