Provider Demographics
NPI:1417238379
Name:HOLSTEN, TONIA MARIE (CAS C052360518)
Entity Type:Individual
Prefix:MS
First Name:TONIA
Middle Name:MARIE
Last Name:HOLSTEN
Suffix:
Gender:F
Credentials:CAS C052360518
Other - Prefix:MS
Other - First Name:TONIA
Other - Middle Name:MARIE
Other - Last Name:HOLSTEN (JAMBOIS REMOVE)
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:RAS H0908201631
Mailing Address - Street 1:1124 INTERNATIONAL BLVD
Mailing Address - Street 2:
Mailing Address - City:OAKLAND
Mailing Address - State:CA
Mailing Address - Zip Code:94606-4331
Mailing Address - Country:US
Mailing Address - Phone:501-533-0800
Mailing Address - Fax:510-533-0300
Practice Address - Street 1:1124 INTERNATIONAL BLVD
Practice Address - Street 2:
Practice Address - City:OAKLAND
Practice Address - State:CA
Practice Address - Zip Code:94606-4331
Practice Address - Country:US
Practice Address - Phone:501-533-0800
Practice Address - Fax:510-533-0300
Is Sole Proprietor?:No
Enumeration Date:2011-09-06
Last Update Date:2020-01-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAH0908201631101YA0400X
CAC052360518101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)