Provider Demographics
NPI:1720772544
Name:HOLLINGER, AUDREY ALINE (EDS)
Entity Type:Individual
Prefix:
First Name:AUDREY
Middle Name:ALINE
Last Name:HOLLINGER
Suffix:
Gender:F
Credentials:EDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:105 MARSH ISLAND CIR
Mailing Address - Street 2:
Mailing Address - City:SAINT AUGUSTINE
Mailing Address - State:FL
Mailing Address - Zip Code:32095-9644
Mailing Address - Country:US
Mailing Address - Phone:904-325-6074
Mailing Address - Fax:
Practice Address - Street 1:105 MARSH ISLAND CIR
Practice Address - Street 2:
Practice Address - City:SAINT AUGUSTINE
Practice Address - State:FL
Practice Address - Zip Code:32095-9644
Practice Address - Country:US
Practice Address - Phone:904-325-6074
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-06-05
Last Update Date:2023-06-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLSS1746103TS0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TS0200XBehavioral Health & Social Service ProvidersPsychologistSchool