Provider Demographics
NPI:1538779806
Name:HOLLAND, TAYANA LA'TOYA
Entity type:Individual
Prefix:
First Name:TAYANA
Middle Name:LA'TOYA
Last Name:HOLLAND
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3991 MOUNTAIN GLADE DR
Mailing Address - Street 2:
Mailing Address - City:HOLT
Mailing Address - State:MI
Mailing Address - Zip Code:48842-7728
Mailing Address - Country:US
Mailing Address - Phone:810-624-7892
Mailing Address - Fax:
Practice Address - Street 1:3815 W SAINT JOSEPH ST STE A101
Practice Address - Street 2:
Practice Address - City:LANSING
Practice Address - State:MI
Practice Address - Zip Code:48917-3665
Practice Address - Country:US
Practice Address - Phone:517-321-5900
Practice Address - Fax:517-321-5945
Is Sole Proprietor?:Yes
Enumeration Date:2020-08-03
Last Update Date:2020-08-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI6401018414101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional