Provider Demographics
NPI:1558476150
Name:HOLLAND, ANGELA (MS)
Entity Type:Individual
Prefix:MRS
First Name:ANGELA
Middle Name:
Last Name:HOLLAND
Suffix:
Gender:F
Credentials:MS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1625 N 4TH ST
Mailing Address - Street 2:SUITE 102C
Mailing Address - City:COEUR D ALENE
Mailing Address - State:ID
Mailing Address - Zip Code:83814-6178
Mailing Address - Country:US
Mailing Address - Phone:208-755-7198
Mailing Address - Fax:
Practice Address - Street 1:1625 N 4TH ST
Practice Address - Street 2:SUITE 102C
Practice Address - City:COEUR D ALENE
Practice Address - State:ID
Practice Address - Zip Code:83814-6178
Practice Address - Country:US
Practice Address - Phone:208-755-7198
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-08-21
Last Update Date:2015-09-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ID4419106H00000X
ID10049101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)