Provider Demographics
NPI:1952646630
Name:PIERCE, HOLLY LYNG LICHEN (MED)
Entity Type:Individual
Prefix:MS
First Name:HOLLY
Middle Name:LYNG LICHEN
Last Name:PIERCE
Suffix:
Gender:F
Credentials:MED
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 1482
Mailing Address - Street 2:
Mailing Address - City:ASHLAND
Mailing Address - State:NH
Mailing Address - Zip Code:03217-1482
Mailing Address - Country:US
Mailing Address - Phone:603-968-3507
Mailing Address - Fax:603-968-3508
Practice Address - Street 1:84 MAIN STREET
Practice Address - Street 2:
Practice Address - City:ASHLAND
Practice Address - State:NH
Practice Address - Zip Code:03217
Practice Address - Country:US
Practice Address - Phone:603-968-3507
Practice Address - Fax:603-968-3508
Is Sole Proprietor?:Yes
Enumeration Date:2012-12-06
Last Update Date:2012-12-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NH959101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health