Provider Demographics
NPI:1841521382
Name:HOLLENBACH, JAMES GRANT (PCC)
Entity type:Individual
Prefix:
First Name:JAMES GRANT
Middle Name:
Last Name:HOLLENBACH
Suffix:
Gender:M
Credentials:PCC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:771B STATE ROUTE 97
Mailing Address - Street 2:
Mailing Address - City:PERRYSVILLE
Mailing Address - State:OH
Mailing Address - Zip Code:44864-9501
Mailing Address - Country:US
Mailing Address - Phone:419-606-5046
Mailing Address - Fax:419-994-5145
Practice Address - Street 1:771B STATE ROUTE 97
Practice Address - Street 2:
Practice Address - City:PERRYSVILLE
Practice Address - State:OH
Practice Address - Zip Code:44864-9501
Practice Address - Country:US
Practice Address - Phone:419-606-5046
Practice Address - Fax:419-994-5145
Is Sole Proprietor?:Yes
Enumeration Date:2010-01-22
Last Update Date:2012-04-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHE.0701080101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional