Basic Information
| Provider Information | |||||||||
| NPI: | 1487084059 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | HOLLAND | ||||||||
| FirstName: | ASHLEY | ||||||||
| MiddleName: | |||||||||
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| Mailing Information | |||||||||
| Address1: | 9445 FARNHAM ST | ||||||||
| Address2: | |||||||||
| City: | SAN DIEGO | ||||||||
| State: | CA | ||||||||
| PostalCode: | 921231399 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8583804676 | ||||||||
| FaxNumber: | |||||||||
| Practice Location | |||||||||
| Address1: | 9445 FARNHAM ST | ||||||||
| Address2: | |||||||||
| City: | SAN DIEGO | ||||||||
| State: | CA | ||||||||
| PostalCode: | 921231399 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8583804676 | ||||||||
| FaxNumber: | |||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 11/19/2013 | ||||||||
| LastUpdateDate: | 04/29/2020 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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| NPICertificationDate: | 04/29/2020 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 101YM0800X | 7605 | CA | N | Behavioral Health & Social Service Providers | Counselor | Mental Health | 171M00000X | N | Other Service Providers | Case Manager/Care Coordinator | 106H00000X | 118259 | CA | Y | Behavioral Health & Social Service Providers | Marriage & Family Therapist |
No ID Information.