Provider Demographics
NPI:1679944300
Name:HOLTER, ADELINE (LCSW, LAC)
Entity Type:Individual
Prefix:
First Name:ADELINE
Middle Name:
Last Name:HOLTER
Suffix:
Gender:F
Credentials:LCSW, LAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:45 NW GREELEY AVE
Mailing Address - Street 2:
Mailing Address - City:BEND
Mailing Address - State:OR
Mailing Address - Zip Code:97703-2943
Mailing Address - Country:US
Mailing Address - Phone:541-800-0443
Mailing Address - Fax:
Practice Address - Street 1:45 NW GREELEY AVE
Practice Address - Street 2:
Practice Address - City:BEND
Practice Address - State:OR
Practice Address - Zip Code:97703-2943
Practice Address - Country:US
Practice Address - Phone:541-800-0443
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-10-07
Last Update Date:2020-07-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO0000781101YA0400X
1041C0700X
CO10931041C0700X
ORL78981041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)