Provider Demographics
NPI:1952942302
Name:GABANYICZ, HOLLY (MA, LLPC, NCC)
Entity Type:Individual
Prefix:
First Name:HOLLY
Middle Name:
Last Name:GABANYICZ
Suffix:
Gender:F
Credentials:MA, LLPC, NCC
Other - Prefix:
Other - First Name:HOLLY
Other - Middle Name:
Other - Last Name:OSANTOWSKI
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:1514 HARVEST LN
Mailing Address - Street 2:
Mailing Address - City:YPSILANTI
Mailing Address - State:MI
Mailing Address - Zip Code:48198-3317
Mailing Address - Country:US
Mailing Address - Phone:734-221-0185
Mailing Address - Fax:
Practice Address - Street 1:27780 NOVI RD STE 244
Practice Address - Street 2:
Practice Address - City:NOVI
Practice Address - State:MI
Practice Address - Zip Code:48377-3427
Practice Address - Country:US
Practice Address - Phone:248-916-2855
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-10-07
Last Update Date:2024-01-29
Deactivation Date:2024-01-23
Deactivation Code:
Reactivation Date:2024-01-29
Provider Licenses
StateLicense IDTaxonomies
MI6451023502101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Multi-Specialty