Provider Demographics
NPI:1447740972
Name:HOLLAND, WENDIE SUE (PHD)
Entity Type:Individual
Prefix:
First Name:WENDIE
Middle Name:SUE
Last Name:HOLLAND
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:DR
Other - First Name:WENDIE
Other - Middle Name:SUE
Other - Last Name:HOLLAND
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:PHD
Mailing Address - Street 1:389 ANNABLE POINT RD
Mailing Address - Street 2:
Mailing Address - City:CENTERVILLE
Mailing Address - State:MA
Mailing Address - Zip Code:02632-2401
Mailing Address - Country:US
Mailing Address - Phone:774-487-2535
Mailing Address - Fax:
Practice Address - Street 1:389 ANNABLE POINT RD
Practice Address - Street 2:
Practice Address - City:CENTERVILLE
Practice Address - State:MA
Practice Address - Zip Code:02632-2401
Practice Address - Country:US
Practice Address - Phone:774-487-2535
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-05-10
Last Update Date:2018-05-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA7624103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist