Provider Demographics
NPI:1942631262
Name:HOLDEN, MARIE (CSC-AD)
Entity type:Individual
Prefix:
First Name:MARIE
Middle Name:
Last Name:HOLDEN
Suffix:
Gender:F
Credentials:CSC-AD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1302 PENNSYLVANIA AVE
Mailing Address - Street 2:750 HOSPITAL WAY
Mailing Address - City:HAGERSTOWN
Mailing Address - State:MD
Mailing Address - Zip Code:21742-3108
Mailing Address - Country:US
Mailing Address - Phone:240-313-3329
Mailing Address - Fax:301-790-1314
Practice Address - Street 1:1302 PENNSYLVANIA AVE
Practice Address - Street 2:750 HOSPITAL WAY
Practice Address - City:HAGERSTOWN
Practice Address - State:MD
Practice Address - Zip Code:21742-3108
Practice Address - Country:US
Practice Address - Phone:240-313-3329
Practice Address - Fax:301-790-1314
Is Sole Proprietor?:No
Enumeration Date:2013-12-12
Last Update Date:2015-01-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDSC0640101Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor