Basic Information
| Provider Information | |||||||||
| NPI: | 1891304226 | ||||||||
| EntityType: | 2 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | HOLLY LO ANN STECKLER | ||||||||
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| Mailing Information | |||||||||
| Address1: | 7785 SAINT GERTRUDE AVE | ||||||||
| Address2: | |||||||||
| City: | RALEIGH | ||||||||
| State: | ND | ||||||||
| PostalCode: | 585644103 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7015973419 | ||||||||
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| Practice Location | |||||||||
| Address1: | 7785 SAINT GERTRUDE AVE | ||||||||
| Address2: | |||||||||
| City: | RALEIGH | ||||||||
| State: | ND | ||||||||
| PostalCode: | 585644103 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7015973419 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 07/31/2020 | ||||||||
| LastUpdateDate: | 07/31/2020 | ||||||||
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| AuthorizedOfficialLastName: | STECKLER | ||||||||
| AuthorizedOfficialFirstName: | HOLLY | ||||||||
| AuthorizedOfficialMiddleName: | LO NN | ||||||||
| AuthorizedOfficialTitleorPosition: | CASEMANAGER | ||||||||
| AuthorizedOfficialTelephone: | 7015973419 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialCredential: | LBSW | ||||||||
| NPICertificationDate: | 07/31/2020 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 261QR0405X | Y | Ambulatory Health Care Facilities | Clinic/Center | Rehabilitation, Substance Use Disorder |
No ID Information.