Provider Demographics
NPI:1457445173
Name:HOLLAND, CYNTHIA LOU (LCSW)
Entity Type:Individual
Prefix:MRS
First Name:CYNTHIA
Middle Name:LOU
Last Name:HOLLAND
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1101 S. BELCHER RD,
Mailing Address - Street 2:SUITE E
Mailing Address - City:LARGO
Mailing Address - State:FL
Mailing Address - Zip Code:33771
Mailing Address - Country:US
Mailing Address - Phone:727-533-9332
Mailing Address - Fax:727-524-1332
Practice Address - Street 1:1101 S. BELCHER RD,
Practice Address - Street 2:SUITE E
Practice Address - City:LARGO
Practice Address - State:FL
Practice Address - Zip Code:33771
Practice Address - Country:US
Practice Address - Phone:727-533-9332
Practice Address - Fax:727-524-1332
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-03
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLSW5594101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLE3375Medicare ID - Type Unspecified