Provider Demographics
NPI:1780086199
Name:SANTOS, HOLLY (BS, MA)
Entity type:Individual
Prefix:MS
First Name:HOLLY
Middle Name:
Last Name:SANTOS
Suffix:
Gender:F
Credentials:BS, MA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2319 N 45TH ST STE 314
Mailing Address - Street 2:
Mailing Address - City:SEATTLE
Mailing Address - State:WA
Mailing Address - Zip Code:98103-6979
Mailing Address - Country:US
Mailing Address - Phone:206-717-4801
Mailing Address - Fax:
Practice Address - Street 1:2319 N 45TH ST STE 314
Practice Address - Street 2:
Practice Address - City:SEATTLE
Practice Address - State:WA
Practice Address - Zip Code:98103-6979
Practice Address - Country:US
Practice Address - Phone:206-717-4801
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-09-17
Last Update Date:2021-06-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WA60693148101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health