Provider Demographics
NPI:1477174126
Name:MAUND, HOLLIE SUE (CDCA)
Entity Type:Individual
Prefix:MS
First Name:HOLLIE
Middle Name:SUE
Last Name:MAUND
Suffix:
Gender:F
Credentials:CDCA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5611 GALLIA ST
Mailing Address - Street 2:
Mailing Address - City:PORTSMOUTH
Mailing Address - State:OH
Mailing Address - Zip Code:45662-5520
Mailing Address - Country:US
Mailing Address - Phone:740-529-0083
Mailing Address - Fax:
Practice Address - Street 1:1619 CHILLICOTHE ST
Practice Address - Street 2:
Practice Address - City:PORTSMOUTH
Practice Address - State:OH
Practice Address - Zip Code:45662-3477
Practice Address - Country:US
Practice Address - Phone:740-529-0083
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-05-05
Last Update Date:2020-05-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH172902101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)