Provider Demographics
NPI:1669283974
Name:ST JAMES, HOLLY
Entity type:Individual
Prefix:
First Name:HOLLY
Middle Name:
Last Name:ST JAMES
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:920 66TH AVE APT 206
Mailing Address - Street 2:
Mailing Address - City:OAKLAND
Mailing Address - State:CA
Mailing Address - Zip Code:94621-3162
Mailing Address - Country:US
Mailing Address - Phone:510-967-5395
Mailing Address - Fax:341-800-4061
Practice Address - Street 1:920 66TH AVE APT 206
Practice Address - Street 2:
Practice Address - City:OAKLAND
Practice Address - State:CA
Practice Address - Zip Code:94621-3162
Practice Address - Country:US
Practice Address - Phone:510-967-5395
Practice Address - Fax:341-800-4061
Is Sole Proprietor?:Yes
Enumeration Date:2025-01-16
Last Update Date:2025-02-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA1282061041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical