Basic Information
| Provider Information | |||||||||
| NPI: | 1710465398 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | BINGHAM | ||||||||
| FirstName: | HOLLY | ||||||||
| MiddleName: | DAVINA | ||||||||
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| Mailing Information | |||||||||
| Address1: | 281 MILLPOND DR | ||||||||
| Address2: | |||||||||
| City: | MANCHESTER | ||||||||
| State: | KY | ||||||||
| PostalCode: | 409627258 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6065942298 | ||||||||
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| Practice Location | |||||||||
| Address1: | 1203 AMERCN GRTG CARD RD | ||||||||
| Address2: | |||||||||
| City: | CORBIN | ||||||||
| State: | KY | ||||||||
| PostalCode: | 40701 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6065287010 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 08/05/2018 | ||||||||
| LastUpdateDate: | 08/15/2018 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 101YM0800X | Y | Behavioral Health & Social Service Providers | Counselor | Mental Health |
No ID Information.