Basic Information
| Provider Information | |||||||||
| NPI: | 1790119063 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | HOLBEN | ||||||||
| FirstName: | MICHELE | ||||||||
| MiddleName: | DONALDSON | ||||||||
| NamePrefix: | MRS. | ||||||||
| NameSuffix: | |||||||||
| Credential: | LASAC | ||||||||
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| Mailing Information | |||||||||
| Address1: | 3825 N 24TH ST | ||||||||
| Address2: | |||||||||
| City: | PHOENIX | ||||||||
| State: | AZ | ||||||||
| PostalCode: | 850166512 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6022488886 | ||||||||
| FaxNumber: | |||||||||
| Practice Location | |||||||||
| Address1: | 3825 N 24TH ST | ||||||||
| Address2: | |||||||||
| City: | PHOENIX | ||||||||
| State: | AZ | ||||||||
| PostalCode: | 850166512 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6022488886 | ||||||||
| FaxNumber: | |||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 08/22/2013 | ||||||||
| LastUpdateDate: | 08/22/2013 | ||||||||
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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 | 101YA0400X | LASAC-13027 | AZ | Y | Behavioral Health & Social Service Providers | Counselor | Addiction (Substance Use Disorder) | 101YA0400X | ICADC 711815 | AZ | N | Behavioral Health & Social Service Providers | Counselor | Addiction (Substance Use Disorder) | 101YA0400X | CADAC 2071 | AZ | N | Behavioral Health & Social Service Providers | Counselor | Addiction (Substance Use Disorder) |
No ID Information.