Basic Information
| Provider Information | |||||||||
| NPI: | 1144379058 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | HOLLISTON | ||||||||
| FirstName: | SABRINA | ||||||||
| MiddleName: | CHANDLER | ||||||||
| NamePrefix: | |||||||||
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| Credential: | BS, SUDP | ||||||||
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| Mailing Information | |||||||||
| Address1: | 3213 80TH AVE NE | ||||||||
| Address2: | |||||||||
| City: | MARYSVILLE | ||||||||
| State: | WA | ||||||||
| PostalCode: | 982706819 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4253306701 | ||||||||
| FaxNumber: | 4252585275 | ||||||||
| Practice Location | |||||||||
| Address1: | 2610 WETMORE AVE | ||||||||
| Address2: | |||||||||
| City: | EVERETT | ||||||||
| State: | WA | ||||||||
| PostalCode: | 982012927 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4255956792 | ||||||||
| FaxNumber: | 4252585275 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 01/09/2007 | ||||||||
| LastUpdateDate: | 04/29/2021 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 04/29/2021 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 101YA0400X | RC00055923 | WA | N | Behavioral Health & Social Service Providers | Counselor | Addiction (Substance Use Disorder) | 101YA0400X | CP60143232 | WA | Y | Behavioral Health & Social Service Providers | Counselor | Addiction (Substance Use Disorder) |
No ID Information.