Provider Demographics
NPI:1316336506
Name:HOLLIER, KRYSTLE CHARON-WOODS (PHD)
Entity type:Individual
Prefix:DR
First Name:KRYSTLE
Middle Name:CHARON-WOODS
Last Name:HOLLIER
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:DR
Other - First Name:KRYSTLE
Other - Middle Name:CHARON
Other - Last Name:WOODS
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:PHD
Mailing Address - Street 1:31 ARDEN PARK BLVD
Mailing Address - Street 2:
Mailing Address - City:DETROIT
Mailing Address - State:MI
Mailing Address - Zip Code:48202-1307
Mailing Address - Country:US
Mailing Address - Phone:313-805-1639
Mailing Address - Fax:
Practice Address - Street 1:2888 W GRAND BLVD
Practice Address - Street 2:
Practice Address - City:DETROIT
Practice Address - State:MI
Practice Address - Zip Code:48202-2612
Practice Address - Country:US
Practice Address - Phone:313-875-5017
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-01-12
Last Update Date:2022-02-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI6301016183103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical