Provider Demographics
NPI:1356827836
Name:HOLLAND, MARISA (LPC, NCC, JSOCC)
Entity Type:Individual
Prefix:
First Name:MARISA
Middle Name:
Last Name:HOLLAND
Suffix:
Gender:F
Credentials:LPC, NCC, JSOCC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2231 VICTORY LN. SUITE 500
Mailing Address - Street 2:
Mailing Address - City:HOOVER
Mailing Address - State:AL
Mailing Address - Zip Code:35216-6303
Mailing Address - Country:US
Mailing Address - Phone:205-677-5199
Mailing Address - Fax:205-778-4311
Practice Address - Street 1:2231 VICTORY LN. SUITE 500
Practice Address - Street 2:
Practice Address - City:HOOVER
Practice Address - State:AL
Practice Address - Zip Code:35216-6303
Practice Address - Country:US
Practice Address - Phone:205-677-5199
Practice Address - Fax:205-778-4311
Is Sole Proprietor?:No
Enumeration Date:2018-07-17
Last Update Date:2019-06-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL3514101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
AL198068Medicaid