Provider Demographics
NPI:1174277891
Name:HOLLEY, KRISTIN DOROTHY (LMSW-CC)
Entity Type:Individual
Prefix:MS
First Name:KRISTIN
Middle Name:DOROTHY
Last Name:HOLLEY
Suffix:
Gender:F
Credentials:LMSW-CC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1489 STATE HIGHWAY 102
Mailing Address - Street 2:
Mailing Address - City:BAR HARBOR
Mailing Address - State:ME
Mailing Address - Zip Code:04609-7021
Mailing Address - Country:US
Mailing Address - Phone:207-288-3388
Mailing Address - Fax:
Practice Address - Street 1:1489 STATE HIGHWAY 102
Practice Address - Street 2:
Practice Address - City:BAR HARBOR
Practice Address - State:ME
Practice Address - Zip Code:04609-7021
Practice Address - Country:US
Practice Address - Phone:207-288-3388
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-02-10
Last Update Date:2022-02-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MEMC182991041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical