Provider Demographics
NPI:1891921979
Name:STONE, HOLLY DUESENBERRY (LADC)
Entity Type:Individual
Prefix:
First Name:HOLLY
Middle Name:DUESENBERRY
Last Name:STONE
Suffix:
Gender:F
Credentials:LADC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 674
Mailing Address - Street 2:
Mailing Address - City:SEARSPORT
Mailing Address - State:ME
Mailing Address - Zip Code:04974-0674
Mailing Address - Country:US
Mailing Address - Phone:207-266-9639
Mailing Address - Fax:
Practice Address - Street 1:5 SCHOOL ST
Practice Address - Street 2:SUITE 106
Practice Address - City:ELLSWORTH
Practice Address - State:ME
Practice Address - Zip Code:04605-1932
Practice Address - Country:US
Practice Address - Phone:207-266-9639
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-06-03
Last Update Date:2024-04-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MELC2336101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)