Provider Demographics
NPI:1295983039
Name:HOLLIDAY, MARIE C (LCAS)
Entity type:Individual
Prefix:MS
First Name:MARIE
Middle Name:C
Last Name:HOLLIDAY
Suffix:
Gender:F
Credentials:LCAS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:705 S MANGUM ST
Mailing Address - Street 2:BAART PROGRAMS
Mailing Address - City:DURHAM
Mailing Address - State:NC
Mailing Address - Zip Code:27701-3904
Mailing Address - Country:US
Mailing Address - Phone:919-683-1607
Mailing Address - Fax:919-683-1790
Practice Address - Street 1:705 S MANGUM ST
Practice Address - Street 2:BAART PROGRAMS
Practice Address - City:DURHAM
Practice Address - State:NC
Practice Address - Zip Code:27701-3904
Practice Address - Country:US
Practice Address - Phone:919-683-1607
Practice Address - Fax:919-683-1790
Is Sole Proprietor?:No
Enumeration Date:2008-09-05
Last Update Date:2012-07-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC1283101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)