Provider Demographics
NPI:1255087318
Name:MAPLES, HOLLY (CMS)
Entity type:Individual
Prefix:
First Name:HOLLY
Middle Name:
Last Name:MAPLES
Suffix:
Gender:F
Credentials:CMS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:48 RANDOLPH ST
Mailing Address - Street 2:
Mailing Address - City:WILMINGTON
Mailing Address - State:OH
Mailing Address - Zip Code:45177-2731
Mailing Address - Country:US
Mailing Address - Phone:937-481-5645
Mailing Address - Fax:937-481-5647
Practice Address - Street 1:48 RANDOLPH ST
Practice Address - Street 2:
Practice Address - City:WILMINGTON
Practice Address - State:OH
Practice Address - Zip Code:45177-2731
Practice Address - Country:US
Practice Address - Phone:937-481-5645
Practice Address - Fax:937-481-5647
Is Sole Proprietor?:No
Enumeration Date:2022-02-28
Last Update Date:2022-06-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
101YA0400X, 171M00000X
OH175T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
No175T00000XOther Service ProvidersPeer Specialist