Provider Demographics
NPI:1144379058
Name:HOLLISTON, SABRINA CHANDLER (BS, SUDP)
Entity Type:Individual
Prefix:
First Name:SABRINA
Middle Name:CHANDLER
Last Name:HOLLISTON
Suffix:
Gender:F
Credentials:BS, SUDP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
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Mailing Address - Street 1:3213 80TH AVE NE
Mailing Address - Street 2:
Mailing Address - City:MARYSVILLE
Mailing Address - State:WA
Mailing Address - Zip Code:98270-6819
Mailing Address - Country:US
Mailing Address - Phone:425-330-6701
Mailing Address - Fax:425-258-5275
Practice Address - Street 1:2610 WETMORE AVE
Practice Address - Street 2:
Practice Address - City:EVERETT
Practice Address - State:WA
Practice Address - Zip Code:98201-2927
Practice Address - Country:US
Practice Address - Phone:425-595-6792
Practice Address - Fax:425-258-5275
Is Sole Proprietor?:No
Enumeration Date:2007-01-09
Last Update Date:2021-04-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WARC00055923101YA0400X
WACP60143232101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)