Provider Demographics
NPI:1629549753
Name:HOLZINGER, TINA MARIE
Entity Type:Individual
Prefix:
First Name:TINA MARIE
Middle Name:
Last Name:HOLZINGER
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:705 W LA VETA AVE STE 208&210
Mailing Address - Street 2:
Mailing Address - City:ORANGE
Mailing Address - State:CA
Mailing Address - Zip Code:92868-4402
Mailing Address - Country:US
Mailing Address - Phone:714-532-9295
Mailing Address - Fax:714-532-9291
Practice Address - Street 1:705 W LA VETA AVE STE 8&210
Practice Address - Street 2:
Practice Address - City:ORANGE
Practice Address - State:CA
Practice Address - Zip Code:92868
Practice Address - Country:US
Practice Address - Phone:714-532-9295
Practice Address - Fax:714-532-9291
Is Sole Proprietor?:Yes
Enumeration Date:2018-12-16
Last Update Date:2019-05-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAR1239481216101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)