Provider Demographics
NPI:1679001549
Name:JASIN, HOLLY MICHELLE (LPC)
Entity Type:Individual
Prefix:
First Name:HOLLY
Middle Name:MICHELLE
Last Name:JASIN
Suffix:
Gender:F
Credentials:LPC
Other - Prefix:
Other - First Name:HOLLY
Other - Middle Name:MICHELLE
Other - Last Name:VANDYKE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:NCC
Mailing Address - Street 1:635 VALLEVISTA AVE
Mailing Address - Street 2:
Mailing Address - City:PITTSBURGH
Mailing Address - State:PA
Mailing Address - Zip Code:15234-1236
Mailing Address - Country:US
Mailing Address - Phone:724-840-7222
Mailing Address - Fax:
Practice Address - Street 1:520 WASHINGTON RD STE 203
Practice Address - Street 2:
Practice Address - City:PITTSBURGH
Practice Address - State:PA
Practice Address - Zip Code:15228-2816
Practice Address - Country:US
Practice Address - Phone:412-668-2038
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-05-23
Last Update Date:2017-05-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAPC009622101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health