Provider Demographics
NPI:1811401177
Name:HOLLAND, LISA MICHELE (MS, LPCC)
Entity Type:Individual
Prefix:
First Name:LISA
Middle Name:MICHELE
Last Name:HOLLAND
Suffix:
Gender:F
Credentials:MS, LPCC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5960 WEST MALL STE B
Mailing Address - Street 2:
Mailing Address - City:ATASCADERO
Mailing Address - State:CA
Mailing Address - Zip Code:93422-4232
Mailing Address - Country:US
Mailing Address - Phone:805-400-7735
Mailing Address - Fax:
Practice Address - Street 1:5960 WEST MALL STE B
Practice Address - Street 2:
Practice Address - City:ATASCADERO
Practice Address - State:CA
Practice Address - Zip Code:93422-4232
Practice Address - Country:US
Practice Address - Phone:805-400-7735
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-11-24
Last Update Date:2017-11-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CALPCC4171101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional