Provider Demographics
NPI:1144661414
Name:COLON, HOLLY LAKIA (LPC, LADC)
Entity type:Individual
Prefix:
First Name:HOLLY
Middle Name:LAKIA
Last Name:COLON
Suffix:
Gender:F
Credentials:LPC, LADC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7 HARWOOD DR
Mailing Address - Street 2:
Mailing Address - City:DANBURY
Mailing Address - State:CT
Mailing Address - Zip Code:06810-8210
Mailing Address - Country:US
Mailing Address - Phone:203-885-2305
Mailing Address - Fax:
Practice Address - Street 1:15 NORTH ST
Practice Address - Street 2:
Practice Address - City:DANBURY
Practice Address - State:CT
Practice Address - Zip Code:06810-5604
Practice Address - Country:US
Practice Address - Phone:475-219-0467
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-07-15
Last Update Date:2019-10-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT1235101YA0400X
CT003540101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
Provider Identifiers
StateIdentifier IDID TypeIssuer
CT1174607253OtherMIDWESTERN CONNECTICUT COUNCIL OF ALCOHOLISM