Provider Demographics
NPI:1063951325
Name:HOLLE, MARY CHRISTINE (APRN, CS, LLC)
Entity type:Individual
Prefix:MS
First Name:MARY
Middle Name:CHRISTINE
Last Name:HOLLE
Suffix:
Gender:F
Credentials:APRN, CS, LLC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:37 MAPLE ST
Mailing Address - Street 2:
Mailing Address - City:SUMMIT
Mailing Address - State:NJ
Mailing Address - Zip Code:07901-2529
Mailing Address - Country:US
Mailing Address - Phone:908-522-0285
Mailing Address - Fax:
Practice Address - Street 1:37 MAPLE ST
Practice Address - Street 2:
Practice Address - City:SUMMIT
Practice Address - State:NJ
Practice Address - Zip Code:07901-2529
Practice Address - Country:US
Practice Address - Phone:908-522-0285
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-02-20
Last Update Date:2017-02-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ26NC04917600101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health