Provider Demographics
NPI:1851780381
Name:HOLLIDAY, MARY (SUD)
Entity Type:Individual
Prefix:MS
First Name:MARY
Middle Name:
Last Name:HOLLIDAY
Suffix:
Gender:F
Credentials:SUD
Other - Prefix:MS
Other - First Name:MARY
Other - Middle Name:
Other - Last Name:HOLLIDAY
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:SUD
Mailing Address - Street 1:1818 GILBRETH RD
Mailing Address - Street 2:230
Mailing Address - City:BURLINGAME
Mailing Address - State:CA
Mailing Address - Zip Code:94010-1225
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:1818 GILBRETH RD
Practice Address - Street 2:230
Practice Address - City:BURLINGAME
Practice Address - State:CA
Practice Address - Zip Code:94010-1225
Practice Address - Country:US
Practice Address - Phone:650-348-6603
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-01-21
Last Update Date:2015-01-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)