Provider Demographics
NPI:1891304226
Name:HOLLY LO ANN STECKLER
Entity Type:Organization
Organization Name:HOLLY LO ANN STECKLER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CASEMANAGER
Authorized Official - Prefix:
Authorized Official - First Name:HOLLY
Authorized Official - Middle Name:LO NN
Authorized Official - Last Name:STECKLER
Authorized Official - Suffix:
Authorized Official - Credentials:LBSW
Authorized Official - Phone:701-597-3419
Mailing Address - Street 1:7785 SAINT GERTRUDE AVE
Mailing Address - Street 2:
Mailing Address - City:RALEIGH
Mailing Address - State:ND
Mailing Address - Zip Code:58564-4103
Mailing Address - Country:US
Mailing Address - Phone:701-597-3419
Mailing Address - Fax:
Practice Address - Street 1:7785 SAINT GERTRUDE AVE
Practice Address - Street 2:
Practice Address - City:RALEIGH
Practice Address - State:ND
Practice Address - Zip Code:58564-4103
Practice Address - Country:US
Practice Address - Phone:701-597-3419
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-07-31
Last Update Date:2020-07-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QR0405XAmbulatory Health Care FacilitiesClinic/CenterRehabilitation, Substance Use Disorder