Provider Demographics
NPI:1043393176
Name:BURKHART, HOLLIS VALE (LMHC)
Entity Type:Individual
Prefix:MS
First Name:HOLLIS
Middle Name:VALE
Last Name:BURKHART
Suffix:
Gender:F
Credentials:LMHC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:107 HILLSIDE AVE
Mailing Address - Street 2:
Mailing Address - City:REHOBOTH
Mailing Address - State:MA
Mailing Address - Zip Code:02769-1307
Mailing Address - Country:US
Mailing Address - Phone:508-252-9489
Mailing Address - Fax:
Practice Address - Street 1:60 BAY SPRING AVE.
Practice Address - Street 2:PATHWAYS WELLNESS CENTER SUITE B1
Practice Address - City:BARRINGTON
Practice Address - State:RI
Practice Address - Zip Code:02806
Practice Address - Country:US
Practice Address - Phone:401-246-0214
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-23
Last Update Date:2011-12-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
RIMHC00226101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health