Provider Demographics
NPI:1548526635
Name:HADDOCK, HOLLY L (MA, CSAC-I)
Entity type:Individual
Prefix:
First Name:HOLLY
Middle Name:L
Last Name:HADDOCK
Suffix:
Gender:F
Credentials:MA, CSAC-I
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:208 AVON DR
Mailing Address - Street 2:
Mailing Address - City:RALEIGH
Mailing Address - State:NC
Mailing Address - Zip Code:27608-1629
Mailing Address - Country:US
Mailing Address - Phone:252-945-9474
Mailing Address - Fax:919-833-8894
Practice Address - Street 1:211 E SIX FORKS RD STE 117
Practice Address - Street 2:
Practice Address - City:RALEIGH
Practice Address - State:NC
Practice Address - Zip Code:27609-7753
Practice Address - Country:US
Practice Address - Phone:919-833-8899
Practice Address - Fax:919-833-8894
Is Sole Proprietor?:No
Enumeration Date:2012-04-03
Last Update Date:2012-04-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health