Provider Demographics
NPI:1558679225
Name:WEBB, HOLLY JO (LADC)
Entity type:Individual
Prefix:MRS
First Name:HOLLY
Middle Name:JO
Last Name:WEBB
Suffix:
Gender:F
Credentials:LADC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1061 DAYTON AVE
Mailing Address - Street 2:
Mailing Address - City:SAINT PAUL
Mailing Address - State:MN
Mailing Address - Zip Code:55104-7297
Mailing Address - Country:US
Mailing Address - Phone:651-815-7814
Mailing Address - Fax:
Practice Address - Street 1:1132 CENTRAL AVE NE
Practice Address - Street 2:
Practice Address - City:MINNEAPOLIS
Practice Address - State:MN
Practice Address - Zip Code:55413-1512
Practice Address - Country:US
Practice Address - Phone:612-236-1700
Practice Address - Fax:612-236-1701
Is Sole Proprietor?:Yes
Enumeration Date:2010-09-16
Last Update Date:2012-09-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN301746101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)