Provider Demographics
NPI:1124631403
Name:HOLLIDAY, ANNA-SOPHIE (MS, NCC, LPC INTERN)
Entity type:Individual
Prefix:
First Name:ANNA-SOPHIE
Middle Name:
Last Name:HOLLIDAY
Suffix:
Gender:F
Credentials:MS, NCC, LPC INTERN
Other - Prefix:
Other - First Name:SOPHIE
Other - Middle Name:
Other - Last Name:LEE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:22518 S PARROT CREEK RD
Mailing Address - Street 2:
Mailing Address - City:OREGON CITY
Mailing Address - State:OR
Mailing Address - Zip Code:97045-9725
Mailing Address - Country:US
Mailing Address - Phone:503-266-3050
Mailing Address - Fax:
Practice Address - Street 1:22518 S PARROT CREEK RD
Practice Address - Street 2:
Practice Address - City:OREGON CITY
Practice Address - State:OR
Practice Address - Zip Code:97045-9725
Practice Address - Country:US
Practice Address - Phone:503-266-3050
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-08-26
Last Update Date:2020-08-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORR6388101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health