Provider Demographics
NPI:1134761794
Name:HOLLAND, HATTIE NICHOLE (MA, NCC, LPC)
Entity type:Individual
Prefix:
First Name:HATTIE
Middle Name:NICHOLE
Last Name:HOLLAND
Suffix:
Gender:F
Credentials:MA, NCC, LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1731 N MARCEY ST STE 510
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60614-7955
Mailing Address - Country:US
Mailing Address - Phone:815-641-8503
Mailing Address - Fax:
Practice Address - Street 1:1731 N MARCEY ST STE 510
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60614-7955
Practice Address - Country:US
Practice Address - Phone:815-641-8503
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-10-15
Last Update Date:2019-10-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL178.014712101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional