Provider Demographics
NPI:1467259200
Name:HOLLIS, HALEY VICTORIA (LCPC-C)
Entity type:Individual
Prefix:
First Name:HALEY
Middle Name:VICTORIA
Last Name:HOLLIS
Suffix:
Gender:
Credentials:LCPC-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:60 FOREST FALLS DR STE 1
Mailing Address - Street 2:
Mailing Address - City:YARMOUTH
Mailing Address - State:ME
Mailing Address - Zip Code:04096-6971
Mailing Address - Country:US
Mailing Address - Phone:207-200-7279
Mailing Address - Fax:
Practice Address - Street 1:60 FOREST FALLS DR STE 1
Practice Address - Street 2:
Practice Address - City:YARMOUTH
Practice Address - State:ME
Practice Address - Zip Code:04096-6971
Practice Address - Country:US
Practice Address - Phone:207-200-7279
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-02-28
Last Update Date:2025-03-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MEXL7965101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional