Provider Demographics
NPI:1942574785
Name:HOLLAND, DONALD EUGENE (LICSW)
Entity Type:Individual
Prefix:
First Name:DONALD
Middle Name:EUGENE
Last Name:HOLLAND
Suffix:
Gender:M
Credentials:LICSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1208 OLENA AVE
Mailing Address - Street 2:
Mailing Address - City:WILLMAR
Mailing Address - State:MN
Mailing Address - Zip Code:56201-4766
Mailing Address - Country:US
Mailing Address - Phone:320-235-0900
Mailing Address - Fax:320-214-3335
Practice Address - Street 1:1208 OLENA AVE
Practice Address - Street 2:
Practice Address - City:WILLMAR
Practice Address - State:MN
Practice Address - Zip Code:56201-4766
Practice Address - Country:US
Practice Address - Phone:320-235-0900
Practice Address - Fax:320-214-3335
Is Sole Proprietor?:Yes
Enumeration Date:2012-02-24
Last Update Date:2012-02-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN151211041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical