Provider Demographics
NPI:1629532098
Name:CRADER, HOLLY (MAADCII, MARS)
Entity Type:Individual
Prefix:
First Name:HOLLY
Middle Name:
Last Name:CRADER
Suffix:
Gender:F
Credentials:MAADCII, MARS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:760 S KINGSHIGHWAY ST STE F
Mailing Address - Street 2:
Mailing Address - City:CAPE GIRARDEAU
Mailing Address - State:MO
Mailing Address - Zip Code:63703-7676
Mailing Address - Country:US
Mailing Address - Phone:573-335-4333
Mailing Address - Fax:573-335-4345
Practice Address - Street 1:760 S KINGSHIGHWAY ST STE F
Practice Address - Street 2:
Practice Address - City:CAPE GIRARDEAU
Practice Address - State:MO
Practice Address - Zip Code:63703-7676
Practice Address - Country:US
Practice Address - Phone:573-335-4333
Practice Address - Fax:573-335-4345
Is Sole Proprietor?:No
Enumeration Date:2019-01-30
Last Update Date:2019-01-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)