Provider Demographics
NPI:1659495893
Name:HOLLADA, SUSAN L (LSW)
Entity Type:Individual
Prefix:MISS
First Name:SUSAN
Middle Name:L
Last Name:HOLLADA
Suffix:
Gender:F
Credentials:LSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:320 S SILVER ST
Mailing Address - Street 2:
Mailing Address - City:LOUISVILLE
Mailing Address - State:OH
Mailing Address - Zip Code:44641-1952
Mailing Address - Country:US
Mailing Address - Phone:330-649-7373
Mailing Address - Fax:330-649-7377
Practice Address - Street 1:4801 DRESSLER RD NW
Practice Address - Street 2:SUITE 130
Practice Address - City:CANTON
Practice Address - State:OH
Practice Address - Zip Code:44718-3667
Practice Address - Country:US
Practice Address - Phone:330-649-7373
Practice Address - Fax:330-649-7377
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-16
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHS.0026584104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker