Provider Demographics
NPI:1942331814
Name:SNYDER, HOLLY (LPC, LCAS)
Entity Type:Individual
Prefix:
First Name:HOLLY
Middle Name:
Last Name:SNYDER
Suffix:
Gender:F
Credentials:LPC, LCAS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:665 W 4TH ST
Mailing Address - Street 2:
Mailing Address - City:WINSTON SALEM
Mailing Address - State:NC
Mailing Address - Zip Code:27101-2701
Mailing Address - Country:US
Mailing Address - Phone:336-725-8389
Mailing Address - Fax:336-725-8389
Practice Address - Street 1:665 W 4TH ST
Practice Address - Street 2:
Practice Address - City:WINSTON SALEM
Practice Address - State:NC
Practice Address - Zip Code:27101-2701
Practice Address - Country:US
Practice Address - Phone:336-725-8389
Practice Address - Fax:336-725-8389
Is Sole Proprietor?:No
Enumeration Date:2007-03-09
Last Update Date:2016-09-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC6497101YM0800X, 101YP2500X
NC1156101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC6103616Medicaid