Provider Demographics
NPI:1356783864
Name:HOLLAND, QUINTON
Entity type:Individual
Prefix:
First Name:QUINTON
Middle Name:
Last Name:HOLLAND
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5139 GREENSIDE DR
Mailing Address - Street 2:
Mailing Address - City:INDIANAPOLIS
Mailing Address - State:IN
Mailing Address - Zip Code:46235-6139
Mailing Address - Country:US
Mailing Address - Phone:317-690-7701
Mailing Address - Fax:
Practice Address - Street 1:5139 GREENSIDE DR
Practice Address - Street 2:
Practice Address - City:INDIANAPOLIS
Practice Address - State:IN
Practice Address - Zip Code:46235-6139
Practice Address - Country:US
Practice Address - Phone:317-690-7701
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-07-25
Last Update Date:2013-07-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health