Provider Demographics
NPI:1558010835
Name:HOLLEN, NATHAN (CADC)
Entity Type:Individual
Prefix:
First Name:NATHAN
Middle Name:
Last Name:HOLLEN
Suffix:
Gender:M
Credentials:CADC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:55 NEWELL ST
Mailing Address - Street 2:
Mailing Address - City:GORHAM
Mailing Address - State:ME
Mailing Address - Zip Code:04038-5814
Mailing Address - Country:US
Mailing Address - Phone:207-619-2497
Mailing Address - Fax:
Practice Address - Street 1:55 NEWELL ST
Practice Address - Street 2:
Practice Address - City:GORHAM
Practice Address - State:ME
Practice Address - Zip Code:04038-5814
Practice Address - Country:US
Practice Address - Phone:207-619-2497
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-03-22
Last Update Date:2022-03-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MECAC5926101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)