Provider Demographics
NPI:1588719371
Name:HOLLAND, SUSAN L (LCSW)
Entity type:Individual
Prefix:MS
First Name:SUSAN
Middle Name:L
Last Name:HOLLAND
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:667 LIGHTHOUSE AVE
Mailing Address - Street 2:SUITE 301
Mailing Address - City:PACIFIC GROVE
Mailing Address - State:CA
Mailing Address - Zip Code:93950-2665
Mailing Address - Country:US
Mailing Address - Phone:831-241-2534
Mailing Address - Fax:831-372-4552
Practice Address - Street 1:667 LIGHTHOUSE AVE
Practice Address - Street 2:SUITE 301
Practice Address - City:PACIFIC GROVE
Practice Address - State:CA
Practice Address - Zip Code:93950-2665
Practice Address - Country:US
Practice Address - Phone:831-241-2523
Practice Address - Fax:831-372-4552
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-24
Last Update Date:2011-09-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CALCS90681041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical